A reader recently could opt for a cashless claim or pay cash and then be reimbursed in a network hospital—an account.
This is my experience when encountering a Cashless VS Reimbursement situation a few months ago in 2023 (the story was shared with us in Feb 2024). The hospital offered a package for the procedure for 80k (at a discounted price). But this was only possible with cash payment.
However, I went ahead with a cashless claim due to the circumstances. That’s when I learned that the public admissions rates differ from the TPA-negotiated cashless rates. For example, the room rent for open public (reimbursement) is 5,500, and the TPA-cashless rate is 3800. As mentioned in your article, this hospital is part of the approved hospital list provided by the PSU insurer. As you have pointed out several times in your health insurance articles, many hospitalization rates are tagged to room rents.
The final cashless bill came to around 75K (out of which the insurer paid 70K). This was better than the package that they offered. The package was for three days. But in our case, the treatment was extended to 4 days. If I hadn’t taken the package and if I had gone the reimbursement option, the final bill would have crossed 1 Lakh. As mentioned in your article, this hospital is part of the approved hospital list provided by the PSU insurer.
Most of the public is unaware of this scenario when choosing cashless vs reimbursement. I thought through your article that some can be aware of this pricing difference between cashless and reimbursement.
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Editors note: The reader sent this account in response to Cashless versus Reimbursable Hospitalization: Which is better?
Our recommendations: Choose cashless whenever possible, but ensure plenty of cash is in hand. Develop a long term relationship with a family physician and involve them in hospitalizations.