Will Cashless Everywhere Scheme Improve Healthcare Access
In a bid to improve the health insurance facility, the General Insurance Council (GIC) unveiled the 'Cashless Everywhere' scheme in January. It is said that any medical insurance policyholder can now access the cashless scheme for treatment in any hospital, whether the hospital is on the third-party administrator (TPA) panel or not. Under this facility, the patient-policyholder can approach any hospital and request cashless treatment.
“Currently, a significant portion of hospitalisation claimed, around 35-40 per cent, operated on a reimbursement basis. This required customers to front the expenses and submit documentation to the insurer, leading to financial burden and delays. With the 'Cashless Everywhere' initiative, insurers now offer cashless services at any hospital," said TATA AIG General Insurance's Executive Vice President and National Head – Accident & Health Claims, Rajagopal Rudraraju.
He added that this not only reduces the financial burden on customers, especially in high-value claims but also takes advantage of hospitals' expertise in managing claim documentation, making the entire process simpler and faster.
Network
It is said that the impact on network hospitals is expected to be minimal, given that many high-volume hospitals are already part of insurers' networks. The primary focus of the initiative is to alleviate the burden on customers, particularly at hospitals with lower claim volumes. This ensures that the relationship between insurance companies and their existing network hospitals remains largely unaffected, said Rudraraju.
It is also important to acknowledge the challenges that come into play while implementing such a programme. Shedding light on one such challenge, Onsurity’s Chief Claims Officer, Suman Pal, highlighted the potential reluctance of hospitals to agree to insurer terms, which may necessitate patients opting for reimbursement instead of cashless treatment.
“Additionally, timely claim intimation remains imperative, with a requirement to notify insurers 48 hours before planned hospitalisation and within 24-48 hours after an unplanned admission,” he added.
Awareness
Whenever such schemes come into the picture, creating awareness becomes a challenge for people to understand and take advantage of them. While discussing the impact of 'Cashless Everywhere,' hospitals are reluctant to respond to it.
Tata AIG’s post-claim settlement NPS surveys indicated a significantly higher customer satisfaction for those utilising cashless services compared to reimbursement claims. There are two key aspects likely contributing to this enhancement. Firstly, the initiative reduces the financial strain on customers by eliminating the need to pay the hospital upfront. Secondly, hospitals, being more adept at handling administrative aspects of claims, contribute to faster settlement times, ultimately improving the overall experience for policyholders.
Despite challenges, the initiative showed that insurance companies are adapting to what customers need. It highlighted a move towards making insurance policies more customer-friendly, focusing on making healthcare services easier to use.
Pal said that the initiative combines all insurers' hospitals into one network, covering about 40,000 hospitals. Insurers agree to accept claims from non-network hospitals, treating them like they are part of the network.
“While the initiative seems promising for improving healthcare access and encouraging more people to get health insurance, its success depends on effectively addressing challenges. As insurers keep innovating and meeting customer needs, we expect more initiatives to improve the overall insurance experience, especially for policyholders,” he added.
