Health insurance provides us with financial security and access to medical services for individuals and families. By offering coverage for various healthcare expenses such as hospitalisation, medical treatments, and prescription medications, it eliminates the burden of hefty medical bills.
The health insurance claim process includes a few steps that policyholders must complete to seek reimbursement or get direct payment for covered medical services. Understanding the claim process is vital, as it ensures timely access to funds and helps policyholders navigate the complexities of submitting the necessary documentation and adhering to specific guidelines.
There are primarily two types of health insurance claims, cashless insurance claims, and reimbursement claims. Let’s understand these in more detail.
As the name says, a cashless health insurance claim fundamentally means that policyholders can opt for cashless treatment at their respective insurance provider’s network hospitals. Further, the medical bill gets settled between the insurance provider and the hospital.
By availing of the cashless feature, individuals don’t have to worry about accessing immediate cash during an emergency situation as the payment is taken care of by the concerned insurance company. Taking inflation and rising medical expenses into account, a cashless health insurance claim is a privilege, considering how challenging it can be to meet medical costs efficiently.
Contrary to cashless health insurance claims, those who choose reimbursement health insurance claims have to pay their medical bills by themselves. Later on, upon submitting medical bills to the respective insurance provider, policyholders get their bill amount reimbursed.
With a reimbursement claim, health insurance policyholders have the flexibility to choose any hospital outside their network. It is not mandatory for insured individuals to access medical benefits/ treatment from their providers’ network hospitals.
The following table lists all the key differences between cashless and reimbursement health insurance claims -
|Cashless Health Insurance Claim||Reimbursement Health Insurance Claim|
|To avail of a cashless claim, you must visit a network hospital of your insurance provider.||For reimbursement claims, you can usually visit any hospital even if it is not included in your insurer’s network hospital.|
|In a cashless claim, you don’t have to pay upfront cash for your medical bills.||If you avail of a reimbursement claim, you would be required to pay the amount mentioned in the bill and submit it to your provider for reimbursement.|
|When it comes to making a claim with your insurance plan, you must inform your provider in advance and submit the claim so that the provider directly settles the bill with the hospital.||In a reimbursement claim process, you must file your claim after the treatment and submit hospital bills for reimbursement.|
|Cashless claim processes are usually quick.||Reimbursement claim processes generally take more time than cashless claims.|
While the exact process will depend on your chosen provider, you can check out the commonly-followed process for claiming cashless health insurance -
To make a reimbursement claim, follow these steps -
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