Is Cashless Better than Reimbursement Claim in Health Insurance?

Generally speaking, yes. A cashless claim process is comparatively better than the reimbursement claim process under health insurance because it is more convenient. Before we proceed further, let’s understand the working of both.

How does reimbursement claim work in medical policies? 

In a reimbursement claim, the policyholder (the patient) foots the medical bills out of his/her pocket. Then the policyholder files the claim with the insurer submitting all relevant documents like bills, doctor certificates, etc. The insurer verifies the claim and then reimburses the costs up to the sum assured by the plan.

How does a cashless claim work in medical policies? 

In a cashless claim, the hospital sends the bills directly to the insurer. The insurer then verifies the claims and settles the bills directly with the hospital. The policyholder (aka the patient) does not have to pay the costs out of his/her pocket.

Here is why policyholders prefer cashless claims:

• Medical emergencies take a toll on the patient and the family members both mentally and financially. Amidst all this, it is preferable not to be bothered by the need to pay for hospital expenses from your pocket, as is the case with a Reimbursement Claim model. Instead, it would take a lot of load off the patient and the family members if the insurance company deals directly with the hospital, as is the case with a Cashless Claim.

Points to Keep in Mind:

Note that a cashless claim works only if the hospital you visit is a part of your insurance company’s list of network hospitals. Thus, it is important to select an insurance company that has a long list of network hospitals if you wish to benefit from the cashless claims.

Although the cashless process is better in terms of convenience, the reimbursement model is not flawed. It’s just tedious. You will have to keep all the bill receipts and important documents in a proper folder and then apply for claim settlement, which might take some time. But it is not like the insurance company will not honour the claim (assuming all terms and conditions are met).

The choice between cashless vs reimbursement boils down to convenience. Cashless claim settlement certainly scores over reimbursement claim settlement in this regard.