Cashless vs Reimbursement: What Retail Health Policyholders Need to Know

Understanding the Basics

When you buy health insurance, the assumption is simple: pay your premium, get treated, and the insurer covers the rest. But in reality, claims can behave very differently, and knowing the difference between cashless and reimbursement can make a huge difference.

• Cashless: The insurer pays the hospital directly. Convenient, but comes with caveats.
• Reimbursement: You pay the hospital first, then get repaid. More flexibility, but requires documents and patience.

How Cashless Works And Where It Trips You

Cashless sounds stress-free, but there are limits:

• Network hospitals only: Outside the network? You pay upfront.
• Pre-authorization delays: Documentation delays

Reimbursement: Flexible, But you have to pay upfront

Reimbursement gives freedom:

• Pick any hospital
• Avoid network restrictions
• Full reimbursement possible if you submit everything properly

Downsides? Paperwork, delays, answer queries and the risk of missed receipts.*