The use of digital wallets is on the rise. Add money to your digital wallet and you can avoid the hassle of carrying cash. Using the money in your digital wallet you can shop online, book a taxi, and even buy movie tickets. With each transaction, the amount due will be deducted directly from your digital wallet.
Making a cashless claim is somewhat like that. You buy the medical insurance plan and pay the premiums. If you need hospitalisation, you do not need to pay for anything that your insurance already covers. The insurer will settle the medical bills directly with the hospital.
The other option in health insurance is the reimbursement plan. Here, you pay the medical bill yourself. After discharge from the hospital, you have to submit the claim papers with the insurer within a certain timeframe. The company verifies the claims. If everything meets the terms and conditions, it reimburses the claim amount.
Let us look into the positives and negatives of a cashless claim in some detail to understand it better.
Advantages of cashless claims (vis-à-vis reimbursement claims):
Get the best medical treatment without burning a hole in your pocket:
Since the insurance companies select them, the hospitals are often the best. So, you get the best medical care without having to pay the hospital anything. The hospital gets in touch with the insurer for all the payments. In a reimbursement claim, you can get treated at a non-network hospital as well. Such a hospital might closer to your home. Or it might be your only option if you are tied to a specific doctor. But you would also need to foot the bill at once and get the money later.
Acts as a safeguard against hospital fraud:
If any hospital of the insurance network is involved in some kind of fraud, the company can take legal action. The insurance company and the hospital sign a memorandum of understanding. It gives the former the power to check and control any such fault on the part of the hospital. The insured is spared the hassles of direct legal proceedings. But, in a reimbursement plan, you have to deal with any dispute with the hospital yourself.
Avoid the hassles of maintaining medical expense records:
In a reimbursement plan, you have to maintain all bills, prescriptions, reports, and the discharge summary. You have to then fill in the claim forms and submit everything to the insurance company for reimbursement. But, in a cashless scheme, you do not have to bother about maintaining these records. The hospital sends these details directly to the insurance company.
Yearly medical checkups:
Some of the insurers who provide the cashless claim benefit offer yearly checkups as part of their package. Yearly medical checkups make sure that all vital statistics of a person get checked. So, any abnormality can be promptly identified and treated.
Disadvantages of cashless claims:
Get the service only in network hospitals:
As said earlier, cashless claim services are available only in the network hospitals of the insurance company. This has a positive as well as a negative side. The disadvantage is that the choice of hospitals is restricted. If, for any reason, you cannot access any of the network hospitals, you have to follow the reimbursement process to get your money back. A reimbursement plan imposes no such restriction on the choice of hospital.
Discharge process is much longer:
The insurer will not clear the payments until all the bills and proofs are validated. So, the completion of the discharge process takes a bit longer in a cashless claim. The discharge process in a reimbursement claim is comparatively shorter, say, by about an hour or two.
Future premiums could go up:
Since the insured does not have a choice of hospital in the case of cashless facility, more often than not, the hospital is an expensive one. This may result in an increase in the future premium amount. But, in a reimbursement plan, the insured has the freedom to choose an affordable hospital. So, the premium may remain constant or not go up too much.
Cashless claim is a convenient health insurance option. It eases the financial strain on you at the already stressful time of hospitalisation. A cashless claim ensures the best treatment without any hassle of maintaining paperwork. It has a few negatives, like the longer discharge period. But the positives weigh much more than the negatives do. If you do not have a cashless mediclaim policy yet, buy one today. If you ever need hospitalisation, you will have peace of mind and hassle-free treatment.