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What Is A Cashless Mediclaim Policy?

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Let us consider that you suffer a serious ailment and are admitted to the hospital. You are not in a position to help yourself. Under such conditions a cashless policy comes to your aid. This policy allows you to be hospitalized or undergo a surgery and the insurance company settles the bill directly through a TPA. The drawback of the cashless facility is that you have to go only to a hospital which is on the TPA Approved list mentioned by the Insurance Company on its website. Once you are admitted in the hospital which is covered by the network you need to give your card number and you will not incur any costs while undergoing the necessary treatment. You need to note that the type of treatment, surgery and the hospital is on the approved list.

How Does Cashless Mediclaim Policy Work?

·         Under this policy you get admitted in a hospital for surgery or a medical condition which is approved by the TPA .

·         You need to mention your card number and get the treatment without paying any cash.

·         The TPA who is an important intermediary between the hospital (On behalf of the patient) and the Insurance Company sanctions the cashless process.

·         In case of an emergency the TPA cannot take more than 6 Hours, and not more than 4 days for sanctioning the process for any other medical condition.

·         In an emergency you only need to display the cashless card at the hospital.

 

What Can Go Wrong In A Cashless Policy?

The aim of the cashless policy is to provide the maximum assistance during the time of a serious illness to the policyholder. But What Can Go Wrong In Such A Policy? Let us consider Mr. Debasis who has a cashless health policy. He works in a bank and is hospitalized for an accident. He informs the TPA within the requisite time period. He is admitted for a surgery in a hospital which is approved on the TPA list and also the surgery is approved. He assumes that the whole process is a smooth one and there are no hassles. However Mr. Debasis was in for a nasty shock. In spite of having a cashless policy he was forced to pay the hospital bills of INR 50000 Up Front and then he got the reimbursement. Even inspite of having a cashless card he never got the cashless benefits due to the mistake of the hospital. He was forced to go for reimbursement in spite of having a cashless scheme.

 

Why Does This Happen?

 

·         Many times the mistake is committed by the policy holder as they are not aware of the working of the cashless facility. They do not inform the TPA on time and call them at the last minute. There is confusion on the part of the hospital as well as the TPA due to this. There is a need to renew policies otime, as well as check which medical conditions and hospitals are covered under this scheme.

·         The TPA’s do not stick to their claimed turnaround times which is under 6 hours in an emergency .Cashless schemes are not settled sometimes even for a week.

·         Let us consider a case in which a person suffers from a medical condition .The first question the hospital asks him is whether he is insured under a cashless scheme. What is the reason for this? In this case the hospital recommends the patient to go for an expensive medical procedure as the Insurance Company and TPA settle the claims and have to shell out the sum of money. The hospital profits at the cost of the Insurance Company .This has resulted in the disbanding of a number of cashless facilities in a number of insurance companies.

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