A person can claim for their treatment in two ways, they are: 1. Cashless Claims 2. Claim Reimbursements. Cashless Claim: A cashless claim means you (as a policyholder) do not have to pay the hospital bill (apart from a nominal amount). This is because your insurance company will settle it with the hospital as part of the claim settlement if it is a network hospital. Within Cashless Process, there are also two types, i.e., Planned and Emergency. In case of planned admission, you have to take upfront approval from the insurance company for cashless treatment. In Emergency cases, you need to inform the Insurance company within 24 to 48 hours of hospitalization. To avail of the cashless process's benefits, you have to provide the insurance company the complete information about your treatment. This information includes the hospital you are going for treatment, the kind and mode of treatment, any existing chronic illness, the estimated cost going to be pay, etc. The Insurance company will review the details and will provide the approval to the hospital. Subsequently, only the hospital will initiate your cashless claims process. Reimbursement Claim: The Reimbursement Claim for health insurance can be made if the policyholder opts to go to a hospital of his/ her choice, a non-network hospital. Here, you directly go to the hospital and pay for all the expenses; subsequently, the costs are reimbursed from the Insurance Company/TPA. In this case, the cashless claim facility cannot be used as the hospital is a non-network hospital. Therefore, the insured has to pay all his/ her medical bills and other costs involved in hospitalization and treatment and then claim reimbursement. To avail reimbursement, you have to provide the necessary documents, including original documents (Bills, Reports, Discharge Summary), etc., to the insurance provider. The company will then evaluate the claim and assess against the coverages under the policy. It will then accordingly makes a payment to the insured. At BimaXpress, we are committed to improving your Claims Experience whether you are opting for a Claims Reimbursement or Cashless Claims. If you are looking to file for a Claim Reimbursement, please download our app called 'BimaXpress' from Apple or Google App Stores.
20 October 2021