Cashless Everywhere: A Game Changer for Healthcare in India


Cashless Everywhere: A Game Changer for Healthcare in India

In a major reform for the healthcare industry in India, general and health insurance companies have come together to launch a revolutionary initiative called “Cashless Everywhere.” This initiative aims to transform the way medical claims are settled by allowing policyholders to get cashless treatment at any hospital they choose, regardless of whether the hospital is part of the insurer’s network.

Traditionally, policyholders have had to pay for treatment upfront if they were admitted to a hospital outside their insurer’s network, and then claim reimbursement later. This process could be cumbersome, time-consuming, and stressful, especially during a medical emergency. Additionally, it was prone to fraud, as some hospitals inflated bills or performed unnecessary procedures to maximize their claims.

The “Cashless Everywhere” initiative seeks to address these challenges by introducing a more streamlined and transparent system. Under this initiative, policyholders will only need to inform their insurance company about their planned hospitalization, and the insurance company will settle the bills directly with the hospital. This will eliminate the need for out-of-pocket payments by the policyholder, making healthcare more accessible and affordable.

The Initiative has Several Key Benefits for Both Patients and Insurers:

For Patients:

  • Reduced financial burden: Patients will no longer have to worry about upfront payments or claim reimbursements, easing the financial stress during a medical emergency.
  • Wider access to healthcare: Patients will have the freedom to choose any hospital, regardless of its network affiliation, ensuring they receive treatment from the best specialists or at the most convenient location.
  • Improved treatment experience: With the financial aspect taken care of, patients can focus on their recovery without worrying about bills.

For Insurers:

  • Reduced fraud: The direct settlement of bills with hospitals will minimize the scope for fraudulent claims, leading to cost savings for insurers.
  • Improved customer satisfaction: By providing a hassle-free claims experience, insurers can enhance customer satisfaction and loyalty.
  • Increased market penetration: The wider access to healthcare offered by “Cashless Everywhere” could attract more people to opt for health insurance, expanding the insurance market.

The “Cashless Everywhere” initiative is still in its initial stages, and there are some challenges that need to be addressed. Here’s some as observed by us over the last six months.

  • The Hospital might at times not be willing to agree to the terms of the Insurer and the patient might then have to opt for a reimbursement nonetheless.
  • Considering the prevalence of fraud, Insurers request patients to intimate them about 48 hours prior to a planned hospitalization and about 24-48 hours after an unplanned one.
  • Retail Customers need to be extra cautious and call their Insurer as soon as they can.

Despite these challenges, “Cashless Everywhere” represents a significant step forward for healthcare in India. It has the potential to make healthcare more accessible, affordable, and efficient for millions of people. By working together, insurers, hospitals, and the government can ensure that this initiative fulfills its promise and revolutionizes the way healthcare is delivered in India.

In case of further queries with regards to hospitalization that is not in a planned network hospital, we are just a phone call away.

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Susheel Agarwal