Why ‘Cashless Anywhere’ holds immense potential for the health insurance industry

Siddharth Singhal, Business Head – Health Insurance, Policybazaar talks about the “Cashless Anywhere” facility and highlights that with the ‘Cashless Anywhere’ facility, insurers have been enabled to settle claims in a cashless manner whether the treatment is sought in a network hospital or a non-network hospital

Earlier this year, the General Insurance Council launched a landmark initiative, which holds the potential to revolutionise the insurance sector – the “Cashless Anywhere” facility. The idea is to allow policyholders to get cashless coverage for their medical treatment across the country in any hospital of their choice.

There’s no dearth of people who might end up in emergencies requiring immediate treatment. A regulatory step like Cashless Anywhere can potentially address the woes of millions of policyholders. For instance, take Sushant’s case, who got sick during his family vacation to Ooty last year. He was soon diagnosed with multiple gallbladder stones and had to undergo immediate surgery. While his vacation was spoiled, his misery did not end there. When his family informed the hospital authorities about his health insurance policy, they were told that they would have to pay the bills upfront since the hospital wasn’t a part of insurance company’s network. On a vacation, with limited financial resources, they had to rely on credit cards to pay the medical bills. Imagine the anxiety of getting admitted to a hospital only to realise that your insurer does not offer cashless treatment in that hospital.

They filed a claim with their insurer after getting back to Delhi, but it took time, and quite some paperwork, to get the reimbursement for expenses. This all could have been avoided if Sushant had been admitted to a network hospital of his insurer. There, he could have availed of cashless treatment. But his situation demanded urgency. However, with the latest guidelines issued by the General Insurance Council, things are set to change.

Cashless anywhere facility

It’s not uncommon to land up in a non-network hospital owing to an emergency. It could also be due to the unavailability of a network hospital nearby or even a deliberate decision because a particular specialist surgeon works at a non-network hospital. Whatever may be the reason, one had to pay a hefty sum upfront and then go through a cumbersome process to get their expenses reimbursed.

With the ‘Cashless Anywhere’ facility, insurers have been enabled to settle claims in a cashless manner whether the treatment is sought in a network hospital or a non-network hospital. That is great news for policyholders indeed! And it is in line with the plethora of consumer-centric initiatives taken by the IRDAI.

Imagine a world where you can get admitted to any hospital without having to worry about the cash in your pocket and get the treatment you need. You can choose an insurance policy based on its features and not worry about whether a preferred hospital is part of its network or not. You can choose a hospital based on its accessibility and the quality of service and medical infrastructure and not worry if your insurer has a tie-up with it or not. Metro cities, tier-2 and tier-3 cities — you are covered for cashless treatment everywhere. This is the potential this move holds. It gives everyone access to quality healthcare services even in remote or unfamiliar locations.

In times to come, the Cashless Anywhere facility will not only streamline the claims process but will also reduce the paperwork required for both the policyholder as well as the insurer. The entire healthcare experience will be simplified and revolutionised. And the policyholders would be able to focus on what matters most – their health and well-being.

As a new initiative, while it may take some time to get accustomed to, but as more and more policyholders experience this newfound freedom and flexibility, it would lead to a huge leap in building trust; and by extension, greater demand for health insurance.

How cashless anywhere works

Earlier, the concept of network hospitals played a critical role in facilitating cashless claims. All insurance companies have tie-ups with certain hospitals where their policyholders can avail of cashless treatment. So if a patient gets admitted there, they won’t have to worry about the bills as they would directly be settled by the insurance company. This arrangement ensured convenience and peace of mind for policyholders, albeit only if they seek treatment in the listed hospitals.

Now, the scope of this cashless facility has been expanded to all hospitals (barring the blacklisted hospitals) across the country, provided they satisfy certain quality standards. This expansion transcends all barriers related to insurance claims and gives the policyholders a lot more freedom about their healthcare needs.

In an emergency, you can just get admitted to any hospital and inform the insurer within 24 hours and avail of cashless treatment. For planned medical procedures, including surgeries, give a 48-hour notice to the insurer, and you are all set. As simple as that.

Of course, there are certain quality standards that these hospitals must maintain. For instance, they should have at least 15 beds. It is also crucial to avoid blacklisted hospitals at all costs. These are about ~3000 hospitals across the country and same can be checked with your insurance company. If the treatment is sought at such a hospital, the claim will be outrightly rejected, be it a cashless or a reimbursement claim. But overall, the initiative holds immense potential to drive the industry towards customer-centricity and convenience.