Invest Smart 2024: Understanding the 'Cashless Everywhere' facility in health insurance

In what could have a transformational impact on the sector and its stakeholders, health insurance companies have rolled out the 'Cashless Everywhere' initiative. Now, policyholders can access the cashless facility at any hospital in the country, irrespective of whether it's a network hospital or not.

In this episode of Invest Smart, Suresh Sadagopan, Founder of Ladder7 Financial Advisories, sheds light on the benefits of the 'Cashless Everywhere' facility.

Cashless Treatment

Suresh Sadagopan praises the cashless facility, emphasising its role in alleviating the burden for policyholders who previously had to wait for reimbursement of expenses incurred at hospitals outside the insurance company's network.

Sadagopan also expresses concerns about the 48-hour time-frame given to insurance companies to approve cashless treatments. Additionally, it's important to note that policyholders must inform the insurance company at least 48 hours prior to admission for elective procedures and within 48 hours for emergency procedures.

Despite concerns about the approval timeline, Sadagopan describes the initiative as 'consumer-friendly' and expresses optimism that any hiccups could be resolved within 2-3 years.

He also suggests standardising the online authorization form across various medical insurance companies. He argues that this would improve efficiency for hospitals.

Benefits of cashless facility

The cashless facility is not beneficial just for the policyholder but also for the insurance company. Suresh Sadagopan points out that over a period of time, insurance companies can control the expenses.

"Once they (insurance company and hospitals) get into a comprehensive agreement on all possible procedures, hospitalisation and intervention, it is much easier for them to control the expenses. So over a period of time the outflow from the medical insurance companies to the hospitals is expected to come down", says Suresh Sadagopan.

The medical insurance penetration is also expected to go up, says Sadagopan.

"If they (General Insurance Council) popularise it, more and more people will take up this concept of medical insurance because they know they can go to any hospital and get treated", says Suresh Sadagopan.

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