What is the Difference between Planned and Emergency Cashless Hospitalisation?

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Planned cashless hospitalisation or pre-planned treatment requires prior authorisation (48-72 hours in advance). On the other hand, emergency hospitalisation addresses unexpected crises, with approval granted within 24 hours of admission.


In both cases, patients receive care at network hospitals without having to pay up front. But there are differences in timing and the level of urgency to complete documentation. Discover the details by reading ahead.


What is the Difference between Planned and Emergency Cashless Hospitalisation?


For both planned and emergency hospitalisation, treatment is allowed at network hospitals. The methods involve direct cashless claims, with the insurer settling the bills with the hospitals. Here are the key differences between planned and emergency cashless hospitalisation options:



  1. Time of Intimation



  • Emergency: The patient is admitted into the hospital immediately, with a 24-hour window to inform the insurer, post-admission.

  • Planned: The insurer must be informed about the patient’s admission at least 48–72 hours prior to hassle-free processing.




  1. Process of Documentation



  • Emergency: The hospital insurance desk shall send the pre-authorisation request needing approval shortly after the admission process is complete.

  • Planned: Pre-authorisation forms must be completed and approved before entering the hospital premises.



  1. Scenarios of Usage



  • Emergency: Unplanned events such as unforeseen illnesses, accidents, or acute emergencies are best handled this way. Heart attacks, accidental injuries that require immediate attention, or severe infections require immediate hospitalisation.

  • Planned: Planned hospitalisation is best for surgeries that are already scheduled, predictable planned procedures, or pre-booked treatments. Examples include maternity deliveries, knee replacement surgeries, or surgeries for a chronic illness.



  1. Timeline of Approval



  • Emergency: This allows for fast-tracked approval. It can also be converted to reimbursement in case the approval takes longer than expected.

  • Planned: This allows time for verification, reducing the scope for last-minute obstacles.


What are the Key Aspects of the Cashless Hospitalisation Facility?


Cashless hospitalisation allows policyholders to avail of medical treatment at network hospitals without having to make upfront payments. Insurers directly settle the bills, typically requiring pre-authorisation for planned procedures. Emergency circumstances necessitate informing the insurer within 24 hours of the insured’s hospital admission.


Here are the key aspects of the cashless hospitalisation facility:



  1. At Network Hospitals: This facility is available only at the insurer's partner hospitals. So, a wide network of hospitals is an added bonus for those looking to take advantage of this facility.



  1. Need for Documentation: One must have the pre-authorisation form, ID proof, health card, and supporting medical records handy.



  1. Process of Direct Settlement: The insurer must pay the hospital directly, after deducting any non-covered items, deductibles, or co-associated payments.



  1. Benefits of the Facility: This facility reduces financial stress for patients and eliminates the need to file reimbursement claims.


Final Word


Planned and emergency cashless hospitalisation differ in terms of processing and securing timelines. The former is for scheduled treatments, which prompt smooth admission with all approvals in check.


Emergency cashless hospitalisation, on the other hand, is for unpredictable, life-threatening events where one needs to be admitted first. Later, the hospital contacts the insurer (within 24 hours) for quick approval.


The benefit remains consistent in both cases: the insurer settles the bills directly with the hospital.