How To Handle A Cashless Health Claim

With many hospitals suspending cashless health insurance option, here's how to manage your temporary cash requirement and claim for a reimbursement from your insurer later

- Meghna Maiti

Do you have a health insurance policy that offers cashless claims and are still worried if it will work if a hospitalisation situation arises? It's natural to be worried given the recent news of the suspension of settlement of cashless claims related to some prominent insurers, including Bajaj General Insurance, Star Health and Allied Insurance, Niva Bupa Health Insurance and Tata AIG Health Insurance. The measures followed certain disputes between the insurers and hospitals over stagnant reimbursement rates amid rising medical costs.

The issues have been resolved, but during the period, patients were forced to pay large sums upfront and await reimbursements, which usually involves a lengthy process, defeating the purpose of cashless claims.

Under the cashless facility, the insurance company directly settles medical bills with the hospital if the policyholder or their insured family member is admitted for treatment in a hospital that is listed under the insurer's network. This eliminates the need for upfront payment by the insured, except for non-covered expenses or co-payments. This not only provides financial relief, but also expedites access to healthcare, especially during emergencies.

In January 2024, the Insurance Regulatory Development Authority of India (Irdai) launched the “cashless anywhere” initiative, which allows policyholders to receive cashless treatment at hospitals, including those not in their insurer’s network. However, adoption is slow due to low awareness and operational hurdles.

The crises laid bare the ongoing issues in India's health insurance system—frequent claim denials, poor patient protection, and the need for fair pricing and stronger regulatory oversight to prevent future disruptions and safeguard policyholders.

In case you face such a situation in the future, we have a guide for you on how to navigate through the crisis.

Do Not Panic