Instant clearance is not always certain with cashless claims
Most people feel that having a cashless health insurance policy means that they will never have to pay out of their pockets when hospitalized. But it may not be so. In real life, even with cashless policies, hospitals may demand a deposit or upfront payment on admission. That is more because pre-authorisation by the insurance is not instant—or because the hospital wants financial guarantee before treatment is started.
Pre-authorisation is a process, not a guarantee
With cashless claims, the hospital will make an advance request to the insurer for pre-authorisation, including the diagnosis, treatment, and estimated charges. The process can take a couple of hours, or longer on weekends or public holidays. In the meantime, the hospital would typically ask patients to make an advance payment, especially in emergency cases or costly treatments.
Hospitals don't want to gamble with uncovered expenses
Even if your insurer grants the go-ahead, not all aspects of the hospital bill are paid. Registration fees, certain consumables, luxury room upgrades, or non-medical charges are typically out. To prevent incurring the cost later, hospitals may request a deposit in advance and adjust the final bill when the insurer pays the approved figure.
Your insurer's network doesn't include all hospitals
If you’re admitted to a hospital that’s not part of your insurance provider’s network, the claim cannot be processed as cashless. In such cases, you’ll need to pay the full bill first and then file a reimbursement claim. Always check your insurer’s list of empanelled hospitals before admission to avoid surprises.
Some policies offer partial cashless approvals
In some instances, the insurer may approve only a part of the estimated treatment cost on cashless basis. The remainder—specifically for longer hospital stay, co-pay ailments, or uncovered treatments—may have to be incurred by the patient in advance. This puts hospitals in a position to demand interim payments during the hospitalization period itself, even prior to discharge.
Plan ahead to minimize financial strain
Avoid any misunderstanding or delay by carrying your health insurance card, policy details, and proof of ID when visiting a hospital. Use network hospitals whenever possible and ask about advance deposits even if your policy has a cashless facility. In case of an emergency, pre-payment may be the fastest way to get the treatment started while paperwork is done in the background.
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