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Types of Health Insurance Claims: Cashless Vs Reimbursement

What is a Cashless Claim in Health Insurance?

What is a Reimbursement Claim in Health Insurance?

Difference Between Cashless vs. Reimbursement Claims

 

 Here’s a quick table to help you understand the key differences between the two main types of health insurance claims – cashless and reimbursement.

Parameters

Cashless Claim

Reimbursement Claim

What is it?

In a cashless claim, you visit a network hospital and your health insurer will take care of the bills.

In a reimbursement claim, you pay your hospital bills after treatment. Then you must submit these bills and any other medical documents to your insurer to have your claim approved.

What is the claims process?

Choose a network hospital. Get the treatment approved by your insurer in advance. Share your health e-card and ID proof with the hospital authority and fill in the required forms. Share the forms with the Third-Party Administrator and insurer. Wait for the claims to be settled.

Get your treatment done and collect the relevant documents and bills. Once this is completed, fill in the required forms and share the documents with your insurer. Wait for the insurer to process the reimbursement.

How are claims settled?

The insurer will settle the claim directly with the hospital by making the payment on your behalf. You don’t need to pay any cash up front.

You need to pay for all the hospital expenses out of pocket first, and later the insurer will reimburse the expenses.

Do you need to get claims approved?

Yes. You need to get your claims approved by the insurer beforehand. This should be at least 72-hours before in case of planned hospitalization, and within 24-hours in case of a medical emergency.

No, you don’t need to get your claim approved beforehand. But it is a good idea to check with your insurer if your treatment will be covered or not.

How long will your claims take?

At the time of claim settlement, cashless claims are usually settled almost instantly.

Reimbursement claims are initiated after your treatment. Since it requires documents to be verified, it can take between 2 to 4 weeks.

What documents are required?

With a cashless claim, you just need to fill in the required form given by the TPA at the hospital. You don’t need to submit bills or other documents.

For reimbursement, you need to submit your health invoices, including medical bills, doctor’s prescriptions, and any other relevant information.

Is it applicable in all hospitals?

Cashless claims are only applicable with your insurer’s network hospitals.

Reimbursement claims can be done through any hospital. It doesn’t matter if it is part of a network hospital or not.

These days we live in a digital, and cashless world, and that means that digital payments have become the way to go, even when it comes to insurance. And having a cashless health insurance will let you make the most of these benefits. While a reimbursement claim can be done at any hospital, with a cashless claim, you can get your medical treatment done without paying out of your own pocket.

Frequently asked questions