Health insurance policyholders are experiencing instances of suspension of cashless treatment as some insurers and hospitals spar over tariff rates for medical services. Recently, the Association of Healthcare Providers India (AHPI), which represents over 15000 hospitals, threatened to suspend cashless treatment for Star Health Insurance policyholders from September 22 for allegedly unfair practices.
Last month, Niva Bupa Health Insurance suspended cashless treatment service at Max Hospitals. In August, Bajaj Allianz General Insurance and Care Health Insurance got into an argument with AHPI over several insurance issues. Both were warned that their cashless services would be withdrawn, but the issue was eventually resolved through talks.
The issue of the termination of cashless service in some hospitals has put policyholders in a vulnerable spot when it comes to claiming cashless treatment. For thousands of families, it is an obvious concern as to what options are available if an insurer or hospital suspends cashless hospitalization. Read below to know what you should do if the cashless services of insurance providers suddenly get suspended.
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Go for reimbursement
The best course of action is to use the reimbursement mode if cashless treatment is stopped at the hospital where you have to take treatment. Under the reimbursement mode, you will need to pay out-of-pocket for the hospitalization and later file for reimbursement with your insurer. Keep all the diagnostic reports, discharge summary and every original bill ready to claim for reimbursement.
Take treatment in daycare
Find out if the hospital stay can be changed to daycare treatment by contacting your insurance company. Check for treatments which does not require hospitalization and that can be completed in a daycare which will save you from the hassle of hospitalization.
Check your network hospitals
Check your insurer’s website or call customer care to find out if your hospital is still part of the cashless network. If the hospital is listed, you’ll be eligible for cashless treatment. If not, you’ll need to pay upfront and later file for reimbursement.
Consider other options
It might be time to consider changing health insurance if your current provider is not cooperative. Many health insurance plans with better features, such as wider cashless hospital networks, are available on the market today. You can port your coverage to a new insurer without losing your existing benefits as long as you switch before your current policy expires.
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Maintain adequate emergency fund
Liquidity becomes crucial when cashless treatment is unavailable. According to experts, customers should maintain an adequate emergency fund specifically for unexpected health costs. When cashless treatment is unavailable, patients can pay medical expenses upfront and later seek reimbursement.
Track updates
The suspension of cashless treatment is not permanent and may resume once disagreements are resolved. The suspension of cashless treatment at certain hospitals often results from ongoing negotiations between the hospitals and insurers. Once both parties settle their disagreements, the facility might be added back. So, it’s advisable to stay in touch with your insurer for updates.
Beware of blacklisted hospitals
Some hospitals are placed on insurers’ blacklists for indulging in inflated or fraudulent billing. The insurance company’s website has the list of blacklisted hospitals. Insurers don’t honor any claim for treatment taken in a blacklisted hospital.