A simple guide to understanding network hospitals, TPA processes, and approval timelines.
Cashless claims are one of the biggest advantages of modern health insurance in India.
They allow you to get treated without paying upfront, except for non-covered items.
Here is a clear, step-by-step guide on how cashless claims actually work.
1. What Is a Cashless Claim?
A cashless claim means your hospital bill is settled directly by your insurer or TPA.
You pay only for small non-medical expenses like food, consumables, etc.
- Available only at network hospitals
- No need to file reimbursement later
- Very helpful in emergency situations
2. Cashless Works Only in Network Hospitals
Your insurance company has a list of hospitals where cashless treatment is allowed.
If you go to a non-network hospital, you must pay the bill yourself and file a reimbursement.
3. Types of Cashless Claims
A) Planned Hospitalization
- Select a network hospital
- Inform insurer 48–72 hours in advance
- Hospital sends pre-authorization
- Insurer approves → treatment begins
B) Emergency Hospitalization
- Go to the nearest network hospital
- Show your e-card or Health ID
- Hospital sends urgent pre-authorization
- Insurer approves quickly
4. Step-by-Step Process of Cashless Claim
Step 1: Admission
You provide:
- Health insurance card
- Aadhaar, PAN or KYC documents
- Policy number
Step 2: Pre-Authorization
The hospital sends:
- Diagnosis details
- Estimated cost
- Doctor’s notes
- Policy documents
Step 3: Insurer Review
The insurer checks:
- Policy validity
- Waiting periods
- Coverage limits
- Exclusions
Step 4: Approval / Query / Rejection
- Approval: Treatment continues without payment.
- Query: Insurer needs more details, causing delay.
- Rejection: If treatment is not covered.
Step 5: Final Settlement
After discharge, the insurer settles the bill directly with the hospital.
You pay only for exclusions like consumables, extra bed, food, etc.
5. What Is Not Covered in Cashless?
- Registration/admission charges
- Food & attendant charges
- Gloves, masks, personal consumables
- Non-medical items
6. Why Cashless Claims Get Delayed
- Hospital slow in sending documents
- Insurer asks for more info
- Waiting period issues
- Room rent mismatch
- Unclear diagnosis
7. Why Cashless Claims Get Rejected
- Pre-existing disease waiting period
- Treatments not covered
- Incorrect documentation
- Policy expired
- Non-network hospital
8. Tips for Hassle-Free Cashless Claim
- Select a good network hospital
- Keep KYC documents ready
- Inform insurer immediately
- Understand exclusions & waiting periods
- Pay premiums on time
9. Cashless vs Reimbursement
| Feature | Cashless | Reimbursement |
|---|---|---|
| Upfront Payment | No | Yes |
| Paperwork | Hospital handles it | You submit documents |
| Speed | Fast | Slow |
| Financial Burden | Low | High |
Final Thoughts
Cashless claims make hospitalization stress-free, but you must understand how the process works,
what is covered, and how to choose the right network hospital.
At Thodu Insurance, we guide customers at every step to ensure smooth and quick cashless approval.
