Expense Reimbursement:
Health insurance policies provide insured with the benefit of getting the medical expenses reimbursed by the insurer after paying them off, based on the policy terms documented. The cost of various hospital charges such as bed charges, medicines, lab tests, surgeon's fees etc. are paid back to the insured at the time of making a claim. The insured pays the (hospital) expenses incurred, but gets them reimbursed by the insurance company.
Cashless Treatment:
Insurance companies provide policyholders with a wide network of hospital get medical treatment without having to make upfront payments. No payment is required to be done by the insured but the insurer since the clause involves a mutual agreement between both the parties, i.e. the insurer and hospital. In contrast, availing cashless benefit requires TPA approval. The insured can also show the health card at the particular hospital as the proof of insurance cover along with a valid government ID proof. Following are the cases considered:
Planned Hospitalization:
In the case of planned hospitalization, the policyholder needs to have the TPA approval in advance along with the other mandatory documents to be submitted. Fill the pre-authorization form at the hospital with a particular section signed by the treating doctors.
Emergency Hospitalization:
Show the health card issued by the insurer at the hospital along with the pre-authorization form filled appropriately. Get the TPA approval for emergency hospitalization. If failed to get the TPA approval, get the expenses reimbursed later instead. The policyholder might have to show the itemized bill, proof of medical expenses, discharge bill etc for claim reimbursement as the proof of the treatment availed at the particular hospital.
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