What is a cashless claim facility?

Cashless claim settlement means a specialized service provided by an insurance company or a third-party administrator (TPA), where the payment for the cost of treatment undergone by the policyholder is directly made by the insurer to the network provider in accordance with the policy terms and conditions.

Insurance companies have tie-ups with hospitals. If an insured person undergoes treatment at any of the network hospitals, there is no need for the person to pay the hospital bills. The insurer through its TPA arranges direct payment to the hospital.

The policyholder should keep in mind that expenses beyond sub-limits prescribed by the health insurance policy or items not covered under the policy have to be settled by the insured directly with the hospital.

The insured can take treatment in a non-listed hospital. However, in this case, he or she has to pay the bills first and then seek reimbursement from the insurance company. This means that there will be no cashless facility applicable at the medical facility.

There are reports which suggest that some hospitals have not been granting cashless facilities for treatment of covid-19 despite policyholders being entitled for getting cashless treatment under their policy.

In this case, a policyholder can send a complaint to the insurance company concerned.

Recently, health insurance companies were directed by the Insurance Regulatory and Development Authority of India (Iradi) to decide and clear requests for cashless treatment and discharge from hospitals within an hour of receipt of the request.