Starting January 25, 2024, you will have the freedom to choose any hospital – even those outside the network of your health insurance provider – for your treatment on a cashless basis!

Led by the General Insurance Council, the “Cashless Everywhere” initiative was rolled out by Indian general and health insurance companies throughout the country.

To avail such cashless facility, policyholders must inform their insurer at least 48 hours in advance, and in cases of emergency treatments, such the insurer must be notified within 48 hours of admission.

But what is the need for such a facility?

Let’s break it down.

• Policyholders will find it easier to avail treatment without the need to pay up significant amounts from their pockets.
• With claims being processed digitally, Insurers are expected to have faster processing times and better control over fraudulent claims.
• This is one among many steps towards the “Insurance for All by 2047” initiative!

While this initiative aims to significantly improve a policyholder’s positive health insurance experience, the success of this initiative depends on:

• The cashless facility of the non-network hospital aligning with the operating guidelines of the insurance company.
• Whether the insurance company and the non-network hospital are able to reach an agreement within 48 hours.
• Awareness amongst policy holders.
• Hospitals not adopting the cashless facility quickly.

While the cashless facility has always been touted as a solution to fraudulent claims, a risk that needs to be investigate is the possibility of misuse of the facility by healthcare providers.

It is suspected that certain hospitals prescribe irrelevant and unnecessary tests to make full use of the insurance. If these attempts to abuse the cashless facility succeed, they lead to a worse than expected claims experience for the policyholder and the insurance company – leading to an inflation in premiums.

If such items are caught, the insurer usually pays out for the items and treatments it deems relevant. But what about the items that go unpaid for by the insurance company? They often fall to the policyholder for payment out of their pocket!

It’s evident that with any such misuse, the policyholder is the one that pays the price one way or another.

Nevertheless, here’s hoping initiatives like this one help us set the stage for a brighter future for health insurance in India!

This blog post is brought to you by the minds at insurancepe!

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