Everything You Need To Know About Cashless Hospitalisation In Tier-2 Cities

Life in a tier-2 city in India is different from the hustle and bustle of the bigger cities. But the healthcare needs of those living in these cities remain the same as their big city counterparts. Getting a good health insurance policy, including an OPD insurance cover, is the need of the hour for those living in tier-2 cities. And what can set a health insurance apart from its competitors is how well its cashless hospitalisation claims work in the real world. Cashless claims are the easiest way to settle a medical bill arising from hospitalisations. They involve less paperwork and are more financially protective for policyholders.

Here’s everything you need to know about cashless hospitalisation in tier-2 cities.

What is Cashless hospitalisation?

Health insurance companies offer two modes to settle your claims. One is through cashless claims, and the other is through reimbursements. Cashless hospitalisation can be opted for at network hospitals. The network hospitals and the insurance company enter into an agreement that allows the insurer to directly settle medical bills for approved treatments with the hospital. While the policyholder may still have to pay a small amount out of pocket, the largest share of the expenses will be settled between the hospital and the insurer.

Reimbursements are opted for when treatments are carried out at a non-network hospital. The policyholder will have to pay the cost of treatment upfront and later claim it as reimbursement from the insurance company after filing the necessary paperwork. Many prefer cashless hospitalisation, as it is less financially burdensome.

Here are some factors to take into consideration for cashless hospitalisation in tier-2 cities

●      Reviewing your policy: You need to know your health insurance policy inside out before opting for cashless hospitalisation. There are factors such as the waiting period for pre-existing conditions, critical illnesses, and maternity benefits that can get your claim rejected if you have a waiting period. Some procedures may be excluded from coverage altogether. So it's better to review your policy before going in for cashless hospitalisation to see if you are eligible for it under the terms and conditions set by your insurer.

●      Network hospitals: Check if your insurer has a good number of network hospitals empanelled with them in your tier-2 city. Do this well before purchasing the insurance policy. Remember that the best cashless health insurance is the one that promises a large number of network hospitals in your budget. If you have narrowed down the hospital you want for your treatment, check if they are a part of your insurance company’s network hospital list. You can access the list through the insurer’s website and app. Cashless hospitalisation is only possible if the hospital is empanelled with the insurer.

●      Pre-authorisation: Most insurance companies will have to pre-authorise your cashless claim. Before you get admitted for your treatment, you will have to submit certain documents along with a form to your insurer for pre-authorisation. Post-verification, the insurer will give an initial approval that allows the hospital to proceed with your cashless claim. With emergencies, you will need to inform your insurer within 24 hours of admission and then proceed with the pre-authorisation formalities. Pre-authorisation does not guarantee a successful claim. This is only an initial approval, and the claim can still be rejected by the insurer if discrepancies are found post-treatment.

●      Out-of-pocket expenses: While costs for medical treatments may be less in tier-2 cities compared to the metros, factors such as room rent, treatment in question, and duration of stay at the hospital can send the hospital bills soaring. While most of the expenses will be covered by the insurance company with a cashless claim, a small amount will have to come out of the pocket of the policyholder for items like consumables. You may also have to keep in mind sublimits involving room rent and certain treatments, which, when exceeded, can lead to more out-of-pocket expenses even with a cashless claim.

A checklist for a smoother cashless hospitalisation in tier-2 cities

●      Verify if the hospital you have chosen is a part of the network hospitals under your insurer

●      The insurer must be informed of planned hospitalisations 48 hours before admission

●      In case of emergency hospitalisation, the insurer must be informed within 24 hours of admission

●      Pre-authorisation is a must in most cases. So ensure to fill out the pre-authorisation form accurately and attach all relevant documents, including diagnostic reports, consultation notes etc

●      Always have copies of your medical documents, such as diagnostic tests, prescriptions, medical bills, and discharge summaries

While most hospitals in the bigger metros will be empanelled with most insurers, this may not be the case with all the hospitals in tier-2 cities. Policyholders must exercise caution and do due diligence well before committing to a particular insurance plan. While reimbursements are possible for treatments received at non-network hospitals, avoid the hassle of going through the lengthy claim process and opt for cashless hospitalisation.