A couple of months ago, I went to the insurance department of an eye hospital to apply for a cashless claim for my mother’s cataract surgery. I usually chat with hospital staff, particularly those responsible for claim processing. The conversation led to “Cashless Claim vs Reimbursement: Which is better?”
I was surprised to note that the person handling the claim application preferred reimbursement to a cashless claim (perhaps because it meant less work for him!). But my surprise quickly abated when I learnt that his experience in handling hospitalization for his family was next to nothing.
I wanted to argue why cashless is better, but my primary mission was to complete the paperwork, so I left the discussion there. I want to continue it here because I have seen so many readers say the same.
Cashless is strongly recommended if the admission is in a network hospital. The insurer will (if you apply for reimbursement) query why you did not opt for cashless, and there could be further hassles and investigation of the hospital’s discharge and internal case papers.
Aside from the obvious benefit that the claim is cashless (meaning all allowed medical expenses will be paid), it frees you from the hassles of buying medicines from time to time for the patient (practised by some hospitals). Some patient attenders get called in the middle of the night to make a trip to the pharmacy, which can be annoying.
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You only need to prepare the cash for paying the non-admissable or non-medical expenses (about 20-25% of the final bill).
Reimbursement paperwork is a huge pain. The insurer often asks you to get the internal case papers from the hospital, which could cost a small fee.
If cashless claims have so many benefits, why do many favour reimbursement? They worry that the hospital will take advantage of the insurance sum and make them or their loved ones undergo a battery of tests to jack up the bill. This fear is not unfounded but can easily be addressed if we build relationships with doctors, especially family physicians. Never get hospitalized under the care of an unknown doctor unless referred to by a physician (unless it can’t be helped).
So, cashless is the clear winner if available. Sometimes, a cashless claim can be rejected! This means we must be ready to pay the entire bill in cash and then go through the hassles of reimbursement.