Looking At Situations In Which Cashless Claims Might Get Rejected In Health Insurance

Looking At Situations In Which Cashless Claims Might Get Rejected In Health Insurance

The facility of making cashless claims during hospitalisation is one of the main conveniences commonly offered by health insurance policies. Afterall, when you are already weighed down by an illness, the last thing you want to be doing is running around finding ATMs to gather the funds you require. 

With the cashless facility, all you need to do is inform the insurer that you will be seeking treatment soon at one of their network hospitals. You may need to fill up a form too prior to getting admitted. Once you reach the hospital, you simply need to present your health insurance card or policy number to get shown to your room. Every treatment covered under the purview of your policy will get settled directly between the insurance company and the hospital. 

However, there may be certain instances when your claim for the cashless facility might be denied. Knowing what these situations are beforehand will save you from landing in an uncomfortable situation when you need to file a claim. In this regard, let’s take a look at a few situations in which cashless claims might get rejected in health insurance.

  • Incomplete information from the policyholder

The insurer may deny a cashless claim in case the policyholder’s contact details are incomplete or do not work. The cashless facility might also get declined if documentation has been left incomplete on the part of the insured person. 

  • Admission to a non-network hospital

If the policyholder is admitted to a non-network hospital, they will not receive the benefit of cashless treatment. They will have to pay their bills in full and later, make a claim for reimbursement. It is always advisable to go to a network hospital; however, this may not always be possible during an emergency. 

  • Pre-authorization request delay
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If the policyholder does not send the pre-authorization request well in time, they may get denied cashless treatment at the hospital. Remember that the hospital and the insurer need sufficient time to review and approve the request for cashless treatment. So, if you have a planned surgery or any other medical treatment, do inform your insurance provider without delay. 

Finally, do remember that not disclosing correct information at the time of buying health insurance can see your claim get rejected. So be sure to be completely honest when revealing personal information, such as pre-existing illnesses. 

 What can you do if a cashless claim is rejected?

You do not need to worry if your cashless claim is rejected. All you have to do is pay your bills at the hospital and keep all your reports and receipts safely. Once discharged, simply contact your health insurance provider and file a claim for reimbursement as per their policy. Your bills will be reviewed and you will receive reimbursement based on what treatments are included in the scope of your health insurance policy.

We hope this article has helped better your understanding of cashless claims in health insurance. Take care.

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