The Hindu Business Line : Taking the pain out of ‘cashless’ facility

You have paid your medical insurance premium and are fully covered for hospitalisation expenses. You should be able to just walk into a hospital, undergo the treatment and go home without a worry about the bills. It ought to be that easy. But is it?

The facility to avail healthcare services on ‘cashless’ basis, where the hospital would get the bills paid by the insurance company either directly or through a ‘third party administrator’ was introduced seven years ago. Yet it has not become as popular with customers as was desired. There are a number of reasons for this, but the big one is lack of awareness on the part of customers.

Cashless authorisation takes time. Since, except in medical emergencies, hospitalisation is planned much ahead, the customer should inform the hospital that he intends to go through the ‘cashless’ route.

Second, he/she needs to produce the TPA ID card at the time of admission.

Finally, the customer needs to read the policy document charges for ‘non-payable items’ to avoid dismay when the claims are repudiated.

Mr Girish Rao, Managing Director, TTK Health Sevices, says that inadequate information, eleventh-hour requests even for planned hospitalisation, low customer awareness on policy terms and conditions, choosing a non-network hospital when there is an equally equipped network hospital in the vicinity are some of the issues to be addressed to smoothen the cashless process.

The insured should also be aware that rejection of cashless request does not amount to rejection of claim and the insured can lodge his claim for reimbursement later when it would be examined in detail and decided on policy terms, says Mr Rao.

There still may be some issues to the seamless working of cashless facility, the most prominent being unanswered toll numbers of TPAs. Customers can make their cashless request online, through mobile or fax.

Seven points to remember to make ‘cashless’ painless

Keep the health card identification (ID) number where it is easily accessible.

Read the policy documents for coverages and exclusions.

Approach the Third Party Administrator at least a week prior to admission, so that the cashless approval is through by the time of admission.

The family members of the insured should be kept aware of the health insurance policy details and contact numbers of TPAs.

Always counter-sign on the authorisation letters from the TPA and on the final bill of the hospital to be aware of the authorised and billed amounts.

Choose smaller hospitals for minor ailments, so as to conserve the sum insured for any further unexpected hospitalisation for a major ailment.

Keep all the previous insurance policy and claims particulars handy before submitting demand for cashless treatment.

While lack of awareness is one of the main problems, there are others too. Hopefully, these will be addressed over time.

Inadequate number of hospitals, particularly at the taluk level and in larger villages.

Long response time from the TPAs or by the insured defeats the purpose of the cashless facility, especially in case of short hospitalisation.

Lack of awareness among the dependent members about the cashless facility, especially when they live away from the main insured.

Reluctance on the part of some large and also small hospitals to join the network due to the long payment cycles and bill deductions made by the TPAs.

Widespread malpractices being committed by hospitals members, which hampers increasing the number of networked hospitals.

Misconception among the insured that they would receive lower quality of treatment if they avail the cashless facility.

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