What Is The Difference Between A Cashless And Reimbursement Claim In Health Insurance?

By Author: Aneeqa Reza
Total Articles: 12
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In health insurance, there are two primary methods by which you can claim reimbursement for your medical expenses by any of the best health insurance companies in Sri Lanka; Cashless claim and Reimbursement claim. Let me explain the differences between the two.

Cashless Claim
Some of the best health insurance in Sri Lanka offer cashless claim is a hassle-free and convenient process wherein you can avail medical treatment at a network hospital without making any direct payments for covered expenses. Such terms may also be included in employee health insurance plans as well. The process involves the following steps:
• Network Hospital: You must visit a hospital that is empanelled or part of the insurance company's network. These hospitals have a tie-up with the insurance provider.
• Pre-authorization: Before undergoing any major medical procedure or hospitalization, you need to inform the insurance company (or the third-party administrator) and seek pre-authorization. This involves submitting the necessary medical documents, prescribed tests, and treatment details.
• Approval: The insurance ...
... company reviews your pre-authorization request and approves the cashless claim if it meets their policy terms and conditions.
• Direct Settlement: Once the claim is approved, the insurance company settles the medical bills directly with the hospital, and you do not have to pay the covered amount out of your pocket. However, any non-covered expenses or deductibles may need to be paid by you.

Reimbursement Claim
A reimbursement claim involves paying the medical expenses out of your pocket at the time of treatment and then later applying for reimbursement from your insurance company. The process for reimbursement claims typically includes the following steps:
• Paying for Treatment: You receive medical treatment at any hospital of your choice, whether it is a network hospital or not, and pay the medical bills yourself.
• Document Collection: After the treatment, you need to gather all relevant documents, such as medical bills, diagnostic reports, prescriptions, discharge summary, etc.
• Claim Submission: You then need to submit the reimbursement claim along with the collected documents to your insurance company as per their guidelines and within the stipulated time frame.
• Verification and Approval: The insurance company will review the submitted documents to verify if the expenses are covered under your policy. If everything is in order and the expenses are eligible, the claim will be approved.
• Reimbursement: Once the claim is approved, the insurance company will reimburse you for the eligible expenses, which means they will pay you back the covered amount you spent on medical treatment.

In summary, cashless claims allow you to avail medical treatment without direct payments at network hospitals, while reimbursement claims require you to pay the medical bills first and then seek reimbursement from the insurance company by submitting the necessary documents. The choice between the two methods depends on the availability of network hospitals, your preference, and the urgency of the medical treatment. Certain insurance companies may also offer health insurance benefits when a customer gets a personal investment plan in Sri Lanka through them, however this will vary according to the insurance provider.

https://www.hnbassurance.com/insurances/insurance-for-you/savings/overview
https://www.hnbassurance.com/insurances/insurance-for-your-business/prime%20group%20life/overview
https://www.hnbassurance.com/insurances/insurance-for-you/health/overview