Why Is Medical Reimbursement Better Than Cashless Insurance?

by Phume Mdluli

Policyholders are primarily concerned with claim settlement* whether they have a car insurance policy, travel insurance coverage, or health insurance/mediclaim policy. They expect their insurance company to respond quickly in an emergency. Insurance companies are also aware of such expectations regarding online health insurance, so they constantly work to improve their claim process.

Important terminologies:

Before understanding the various various claim resolution procedures, here is an index of essential terminologies to fully comprehend the explanation.

Network hospital: A network hospital has an agreement with a health insurance/mediclaim company to facilitate the processing of claim settlement* applications.

Third-party administrators (tpas): tpas are independent organisations that may be enlisted by the insurance for health /medical claim company to assist in the procedure for settling claims. they produce usually involves coordination.

Cashless claims: A cashless claim means that you (as a patient and policyholder) do not have to pay the hospital bill (other than a nominal amount) because your insurance company can settle it with the hospital (as part of the claim settlement*). After all, it is a network hospital.

Reimbursement claims: a reimbursement claim occurs when you (as a patient and policyholder) pay your hospital bill and then submit the health insurance claim application to your insurance company for applicable reimbursement.

Is cashless preferable to reimbursement?

Yes, in general. Because of the convenience, a cashless health insurance claim process is preferable to a reimbursement claim process in health insurance. Health insurance is concerned with medical emergencies that financially impact the patient and family members.

Among all of this, it is preferable to avoid having to pay for hospital expenses out of pocket, as is the case with a reimbursement claim model. Instead, dealing directly with the hospital, as is the case with a cashless claim, would relieve the patient and family members of a significant burden.

Check if you have a time limit for filing a health insurance claim:

It is important to note that a cashless claim shall only work if the hospital you visit is on your insurance company’s list of network hospitals. If you want to take advantage of cashless health insurance, you should choose an insurance company with an extensive network of hospitals.

Although the cashless method is more convenient, the reimbursement model is correct. It could be more exciting. You must keep all bill receipts and essential documents required for mediclaim reimbursement in a separate folder before filing a claim, which may take some time.

However, it is not as if the insurance company can not honour the claim (assuming all terms and conditions are met).  The decision between cashless and reimbursement claim settlement* comes down to convenience, and cashless claim settlement outperforms reimbursement claim settlement* in this regard.

Online health insurance/mediclaim:

If you believe your current health insurance company has an inadequate network of network hospitals, you can easily switch insurers at the time of renewal by renewing your policy online.

a calculator for medical claims and insurance premiums can help you compare plans. A health insurance/mediclaim premium calculator is simple to use because all you must to do is to click a few buttons and enter some basic information. Furthermore, it is free of charge. When using the calculator, make a list of the requirements that you want the policy to fulfill and see if the sum insured offered in the policy is sufficient in doing that.

“The topic of the solicitation is insurance. Please carefully read the sales brochure/policy wording before finalising a deal for more information on the benefits, restrictions, limitations, terms, and conditions. The topic of the solicitation is insurance. Please carefully read the sales brochure/policy wording before finalising a deal for more information on the benefits, restrictions, limitations, terms, and conditions.”

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