What are the Challenges Involved in a Cashless Mediclaim?

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The COVID-19 pandemic has turned the world upside down, with the most important takeaway being how unpredictable human life is. After hearing so many instances of unfortunate events, by now, we all have realised it’s better to be safe than sorry. And that’s where the cashless mediclaim policy, one of the most popular medical insurance products offered by insurance companies in India, comes into the picture.

The health insurance plan ensures that the insurer doesn’t have to pay a single penny to the hospital, eliminating the hassle of submitting cash at the premises and then applying for reimbursement later. But this doesn’t mean that the health plan is all rosy, as there are multiple challenges with cashless mediclaim.

What is Cashless Mediclaim Policy?

A cashless mediclaim policy is an insurance plan offered by several insurance providers such as Tata AIG to simplify the claim settlement journey. In the plan, policyholders get complete protection against healthcare emergencies without having to incur out-of-pocket expenses.

An insurer can simply walk out of the hospital without paying anything as the insurance settles the claims with the hospital. Insurance companies usually partner with a long list of hospitals to ensure that insureds have an appropriate number of medical facilities accepting cashless mediclaim available near them.

In insurance terms, partner hospitals are termed ‘network hospitals,’ where insurers can avail of cashless medical facilities. The whole process becomes simpler and smoother as the insurer doesn’t have to pay for the medical bills at the hospital. But cashless mediclaim has its own complexities, which are mentioned in this article.

Challenges Involved in a Cashless Mediclaim

Even though a cashless mediclaim plan is a boon for insureds, the health insurance policy still has its fair share of drawbacks as well. For an individual, it’s important to understand the challenges involved in a cashless mediclaim facility.

Here’s the list of challenges faced by insurers secured by a cashless mediclaim policy:

  • Lack of network hospitals

One of the major challenges in this policy is the lack of network hospitals. Finding a network hospital in top-tier cities is easier, but the task becomes a tough nut to crack in second and third-tier cities, towns and villages. Moreover, in case of an emergency, the shortage of hospitals offering cashless treatment can become a hassle. Therefore, you need to check the network hospitals beforehand so that you do not face any hassles if there is an emergency.

  • Complex documentation process

In a few cases, the documentation process in cashless mediclaim policy could be quite burdensome as hospitals could ask for a long list of documents. For many, the process could be annoying.

  • Partial claim settlement

Another reason why many policyholders dislike cashless mediclaim policy is that sometimes hospitals and insurance companies only offer a partial claim settlement. The rest of the amount is left for reimbursement. In such cases, the insurer is required to pay the remaining medical bill, which could burn a hole in individuals’ pockets and lead to hassles if the policyholder does not have an adequate amount at the time.

  • Processing time

Long processing time to settle the claims can be another major turn-off for insurers planning to buy this policy. However, that usually happens while receiving approval from third party administrators. Sometimes, the claim could be put on hold by third-party administrators, which is a problem as you can only go ahead with the cashless mediclaim once you get approval from them. In such cases, the insurer might ask you to pay the bills and get them reimbursed later.

  • Exclusions

There are several mediclaim expenses that are not covered under the cashless mediclaim policy. These charges include registration fees, regular check-up expenses, and documentation charges, among others. Insurers are required to pay the additional expenses from their pocket, leading to a hefty medical bill. Thus, it is advisable to read the terms and conditions of the policy carefully to know the exclusions; otherwise, you might get shocked later.

 Cashless Mediclaim Policies Available in India

In India, insurers offer various cashless mediclaim policies that insurers can buy online or offline. These policies secure the insurers against any unprecedented and unwanted medical emergencies. The types of policies include:

  • Individual cashless mediclaim plan

Individual cashless mediclaim plan provides health insurance benefits only to the insurer. The individual gets medical coverage of up to a certain amount depending on the health insurance plan selected.

  • Senior cashless mediclaim policy

As the name suggests, the senior citizen cashless mediclaim policy is opted by senior citizens seeking medical coverage. The health insurance policy takes care of the hospitalisation expenses at this critical age.

  • Family Floater cashless mediclaim policy

Family floater cashless mediclaim plan is a health insurance plan for family which provides cover for all family members under one policy with a single sum insured irrespective of the fact who bought the plan. The plan covers hospitalisation expenses of family members covered under the policy.

Summing Up

By now, you must have clearly understood all the hiccups involved in a cashless mediclaim policy. However, just like millions of insured customers, you, too, can overlook the few drawbacks to get the enormous benefits of health insurance.  Moreover, insurers can carefully compare all the available healthcare plans in the market before buying one. Make sure to check that hospitals near your residence are covered in the health policy.

Other factors that you need to consider while buying a mediclaim plan are claim settlement ratio, complete claim process, selecting the covered amount, renewal terms and conditions, and free health check-ups, among others. So, take out some time, do your little research and buy the plan that caters to you and your family’s needs the best.