June 23, 2024


Passion For Business

What Is Cashless Claim Settlement?

How Cashless Claim Settlement Works In Health Insurance Explained

Policyholders are generally worried about claim settlement regardless of whether they have an auto insurance policy, travel insurance policy, or health insurance/Mediclaim policy. They anticipate that their insurance provider will act quickly to help them in an emergency. Insurance firms continuously work to improve their claim procedure since they are aware of expectations relating to medical claims and health insurance

Ahead of the game, digital-first insurers use technology to make sure that their policyholders are happy with the claim settlement procedure. To achieve that goal, technologies like blockchain, robotic process automation, and artificial intelligence are being used. 

The Cashless Claim Settlement Process is a straightforward example of a tech-driven plan to make the claim procedure customer-friendly. *

To learn more about it and how it varies from the lengthy Reimbursement Claim Settlement Procedure, continue reading. 

Key Terminologies

Before moving on to comprehending various claim settlement procedures, here is a list of key terms you should be familiar with in order to fully understand the explanation. 

Network Hospital: A network hospital is one that has a relationship with the health insurance or Mediclaim business to facilitate the processing of claim settlement applications. 

Third-Party Administrators (TPA): 

TPAs are independent businesses that the health insurance or medical claims company may use to assist in handling the claim settlement procedure. Usually, their task involves coordination. 

Cashless claims: 

A cashless claim indicates that, because the hospital is a network hospital, your cashless health insurance company will settle it with the hospital (as part of claim settlement), and you, the patient and policyholder, won’t be responsible for paying the hospital bill (aside from a little fee). *

Reimbursement claims: 

A reimbursement claim is one in which you, the patient and policyholder, pay the hospital cost out of pocket before submitting the required health insurance claim paperwork to your insurance provider. *

Is reimbursement preferable to become cashless? 

In general, yes. Because of the simplicity it offers, a cashless claim process is preferable to a reimbursement claim process for health insurance. Health insurance is related to medical emergencies, which take a toll on the patient and the family members. 

In light of all of this, it is desirable to avoid hassles like having to pay for hospital bills out of pocket, which is the situation with a Reimbursement Claim model. Instead, dealing with the insurance company directly, as is the case with a Cashless Claim, would relieve a lot of the burden. *

Keep in mind that a cashless claim only functions if the hospital you visit is on the list of network hospitals maintained by your insurance provider. Therefore if you want to take advantage of cashless claims, it’s crucial to choose an insurance provider with a large network of hospitals. 

Although it is more convenient to use a cashless system, the reimbursement concept is not defective. It’s simply boring. You must organise all of your bill receipts and important papers into a designated folder before applying for claim settlement, which could take some time. Yet, it’s not as if the insurance provider won’t pay the claim (assuming all terms and conditions are met). *

Reimbursement vs Cashless comes down to convenience, and Cashless Claim Settlement is unquestionably more convenient than Reimbursement Claim Settlement and has several health insurance benefits. 

Online Health Insurance/Medical Claim

By renewing your policy online, you can quickly switch insurers if you believe your current health insurance provider has an unsatisfactory list of network hospitals. You can compare plans by utilising a health insurance/Mediclaim premium calculator. A health insurance/Mediclaim premium calculator is simple to use because all you need to do is enter some basic information and click a few buttons. Also, it is free to use.

* Standard T&C Apply

Insurance is the subject matter of solicitation. For more details on benefits, exclusions, limitations, terms, and conditions, please read the sales brochure/policy wording carefully before concluding a sale.