When you are hospitalised, you can claim in two ways: cashless or reimbursement. Knowing the difference will save time and stress during a medical emergency.
What Is a Cashless Claim?
In a cashless claim, the insurer settles the bill directly with a network hospital. You pay only non-payable items, co-payment or deductible, if any.
Cashless Process for a Planned Treatment
- Choose a network hospital.
- Submit the pre-authorisation form to the hospital’s insurance desk, usually 2 to 3 days before admission.
- The insurer approves the estimate.
- After treatment, the hospital sends the final bill to the insurer.
Cashless Process in an Emergency
Get admitted immediately, and inform the insurer or TPA within 24 hours. The hospital will send the pre-authorisation request.
What Is a Reimbursement Claim?
You pay the hospital bill yourself, collect the documents and submit them to the insurer. After verification, the approved amount is credited to your bank account.
Documents for Reimbursement
- Claim form
- Original hospital bills and receipts
- Discharge summary
- Investigation reports and prescriptions
- ID proof and cancelled cheque
Which Is Better?
Cashless is convenient because you do not need to arrange a large amount of money. Reimbursement is useful when you are treated at a non-network hospital or abroad. Try to use cashless whenever possible, but keep all papers ready for reimbursement.
Common Reasons for Delay
- Missing documents
- Wrong or incomplete claim form
- Treatment not covered under the policy
- Claim filed after the deadline
Frequently Asked Questions
Will the insurer always approve cashless requests?
Not always. If the request is rejected, you can still pay and claim reimbursement later.
What is the time limit for reimbursement claims?
Usually within 15 to 30 days after discharge; check your policy.
Can I get cashless treatment at any hospital?
Only at network hospitals of your insurer.
