Cashless Claims Process

A cashless claim is where your insurer settles the hospital bill directly — you walk out paying only the non-covered portions. It works only at network hospitals tied to your insurer or TPA.

Step-by-step

• Intimate the insurer / TPA — before planned hospitalization or within 24 hours for emergencies.
• Show your health card and ID at the hospital's insurance desk.
• Hospital sends a pre-authorization form to the insurer with diagnosis, estimated cost, and treatment plan.
• Insurer reviews and approves a sanctioned amount (fully, partially, or queries for more info).
• On discharge, the insurer settles the approved amount directly with the hospital. You pay only non-covered items (toiletries, meals for attendants, etc.).

What can delay or reduce a cashless claim

• Hospital is non-network or has been delisted recently.
• Sub-limits on room rent — if you pick a higher room category, proportionate deductions cascade across the bill.
• Non-disclosed pre-existing conditions surfacing on diagnostic reports.
• Treatment is in a waiting period.

Pro tip

Confirm the network status of the hospital before admission — networks change. Most insurers have an app or website lookup; some accept WhatsApp queries.