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Everything You Need To Know About Cashless Hospitalization

Sampurna Mitra|4 min read|23 May, 2022

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What Is Cashless Hospitalization?

Medical emergencies can be very stressful. Now add to that, the thought of rushing to an ATM to withdraw money or borrowing from family and friends to pay the hospital bills. Being unprepared for such situations is emotionally and financially draining. This problem can be addressed through health insurance, and more specifically via network hospitals that the insurance company has tied-up with.

PhonePe has partnered with insurers that have 1000s of network hospitals for providing cashless treatment. A health insurance policyholder does not have to arrange for funds to pay for a covered treatment at any of his or her insurer’s network hospitals. Instead, the individual simply needs to inform the insurance desk at the hospital about the treatment. Once the approvals are received, the medical expenses would be directly paid by the health insurer to the hospital.

What are Network Hospitals?

On the PhonePe App, you will come across the term Network Hospitals against different insurance companies. Network hospitals are those hospitals that have entered into an agreement with insurance companies for providing cashless hospitalization. What this means is that you can get treated for an illness or injury at a network hospital and the insurer will directly pay your bills to the hospital, in accordance with the policy terms and conditions.

It is recommended to look for a health insurance provider with a wide network of hospitals. Cashless facility helps protect your finances during emergencies. Without this, you may have to put in considerable time and effort toward arranging funds, collecting and storing bills and other documents and sharing them with your insurer for reimbursement.

Cashless Claim Process

You can raise a cashless claim at a network hospital for both planned hospitalization as well as emergency hospitalization.

Planned Hospitalization:

Planned hospitalization, as the name would imply, is when you have set a date for the procedure and are aware about the treatment beforehand.

Step 1 — You have to submit the filled-up pre-authorization form along with the required documents to the insurance company a few days prior to the hospitalization. The timeframe will differ from insurer to insurer. You can get the pre-authorization form from the insurer’s website or the third-party administrator (TPA).

A TPA functions as a link between the insurance company and a policyholder for cashless claims. The primary role of the TPA is claims processing and settlement.

Step 2 — The insurance company will verify the request. If everything is in order, the insurer will provide a confirmation letter.

Step 3 — Submit this letter and the policy document to the hospital on the day of your hospital admission. The hospital bills will be settled directly by the insurer/ TPA, up to the sum insured limits mentioned in the policy document.

Emergency Hospitalization:

Cashless claims can be filed for unplanned/emergency hospitalization. The steps involved are similar to that of a planned hospitalization with the only difference being the requirement of prior intimation to the insurance company does not apply.

Step 1 — You or any family member would need to intimate the insurer or TPA about the admission within a few hours of being hospitalized. To know the exact time limits, please contact the insurance company.

Step 2 — The insurance desk at the hospital will send your request to the insurance company. You should hear back concerning the approval or rejection within a few hours.

Step 3 — If the insurer approves the request, you can proceed with the treatment. However, if the situation is such that waiting a few hours to hear back is not possible, then the policyholder can file a reimbursement claim. Here, the policyholder would pay for the treatment and upon discharge, apply for reimbursement.

Note — The exact process of filing a cashless claim would differ from insurer to insurer. Please refer to the website of the insurance company to know the steps you would need to follow for cashless hospitalization.

Important Points To Remember When Opting for Cashless Hospitalization

  • Cashless hospitalization facility is only available at network hospitals. Before choosing a health insurance policy, it is recommended to check all the network hospitals near your area.
  • To file a claim, you will need to provide your policy details at the hospital.
  • Carefully fill the pre-authorization form as any incorrect detail could result in your pre-authorization request getting rejected.
  • Familiarize yourself with the timelines to intimate the insurance company, particularly for emergency cashless hospitalization. Failure to do so can result in your cashless hospitalization request getting delayed or denied.

How To Buy Health Insurance On PhonePe?

The process of purchasing health insurance on the PhonePe App is easy.

Step 1 — Open the PhonePe App

Step 2 — Tap ‘Health++’ under Insurance and enter your details. You can also cover your family members.

Step 3 — Choose the Cover amount and enter your pincode. Click on View Plans.

Step 4 — Select the plan of your choice.

Step 5 — Provide additional details, like address, nominee details etc. and proceed to buy the policy.

Your policy document will be immediately sent to your registered e-mail ID. You can find the policy details on the PhonePe App. Just tap Insurance at the bottom of the home screen and select Health++.

Health insurance is a must in this day and age, where without it, medical expenses can burn a hole in one’s pocket. The benefit of a cashless facility rids one from the worry of arranging for money to pay for medical treatment. The insurer not only bears the cost of treatment, the payment is made directly to the hospital (in case of cashless claim), freeing you from the worry of arranging for funds.

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