How Cashless Hospital Networks Work in Health Insurance

10 min read Posted on 17july 2025

In a medical emergency, navigating hospital admissions, payments, and insurance procedures can be overwhelming. A cashless hospital network offers a streamlined alternative, eliminating the need for upfront payments by enabling direct settlement between the insurer and the hospital.

This blog provides a detailed overview of how the cashless claim process works, typical TPA cashless approval time, how to locate the empanelled hospital list in India, and key differences between cashless vs reimbursement claims. Understanding these elements can help you avoid delays, minimise out-of-pocket expenses, and make informed decisions during critical moments.

What Is Cashless Hospitalisation?

Cashless hospitalisation allows you to receive treatment at a hospital without making upfront payments. Your insurer settles the bill directly with the hospital, provided it is part of their cashless hospital network.

In emergencies or planned treatments, this facility saves you from dealing with large payments or tedious paperwork. However, seeking treatment at a hospital empanelled by your insurer is essential.

Cashless hospitalisation is available through most types of policies, including:

• Cashless Individual Health Insurance
• Cashless Family Floater Health Insurance
• Cashless Senior Citizen Health Insurance

How Does the Cashless Claim Process Work?

Below is a simplified overview of the cashless claim process, whether it’s a planned procedure or a medical emergency:

1. Visit a Network Hospital   
   Cashless claims are only supported at hospitals within the insurer’s designated cashless hospital network.
2. Inform the Insurance Desk   
   For a planned hospitalisation, notify the hospital and your insurer at least 48 to 72 hours in advance. For emergencies, intimation within 24 hours is typically accepted.
3. Submit Pre-Authorisation Request   
   The hospital will send a pre-authorisation form to the insurer or the Third-Party Administrator (TPA). This document includes treatment details and estimated costs.
4. TPA Cashless Approval Time   
   Approval is typically granted within 2 to 6 hours for planned treatments. In emergencies, insurers try to approve it quicker, but it may take longer, especially during weekends or holidays.
5. Treatment and Billing   
   Once approved, the hospital provides treatment. The insurer pays the hospital directly. Non-covered items, such as personal expenses or registration fees, may require out-of-pocket payment and any co-pay mentioned in your policy.

How to Find a Cashless Hospital Network

Many policyholders overlook this aspect until it becomes urgent. Here’s how you can find an empanelled hospital list in India for your insurer:

• Check Your Health Card: Many cards include website details or QR codes linking to the hospital list.
• Visit the Insurer’s Website: Use filters like location, speciality, or hospital name.
• Mobile App: Most insurers have apps that allow hospital searches based on GPS.
• WhatsApp Services: Some insurers like Future Generali on RenewBuy’s network offer a chatbot on WhatsApp to help you find a network hospital.
• Toll-Free Support: Contact customer support to request the list via email or SMS.

Common Issues During the Cashless Claim Process

While the process sounds seamless, real-life scenarios often present unforeseen challenges. Here are some common issues and how you can avoid them.

1. Claim Rejection Due to Undisclosed Pre-existing Conditions   
   If you had diabetes but didn’t mention it while buying the policy, your cashless claim might be rejected. Insurance works on mutual disclosure, known as the “Principle of Utmost Good Faith”.
2. Treatment Within Waiting Period   
   Treatments related to pre-existing diseases, maternity, or specific surgeries (e.g., hernia or cataract) often have a waiting period of 1–3 years. Filing a claim during this time can lead to rejection.
3. Room Rent Limits   
   If your policy covers ₹4,000 per day for a hospital room but you opt for one costing ₹6,000, you may have to pay the difference yourself, not just for the room but for other associated costs too.
4. Treatment Not Covered   
   Most policies don’t cover cosmetic surgery, dental work, or experimental treatments. Ensure that you review your policy declarations thoroughly.
5. Policy Lapse   
   If your policy wasn’t renewed or payment failed, even by a day, your claim might not be processed.

Cashless vs Reimbursement Claim: What’s Better?

Both options have their place, but understanding when to use which can save you stress and money.  
 

Recommendation

Whenever possible, opt for a hospital within the cashless network. This approach streamlines the process, minimises paperwork, and mitigates financial burden.

Use Cases That Show the Difference

The following examples illustrate the differences more clearly:

Case 1: Cashless Success

Vinay's mother had to undergo a knee replacement. They went to a listed hospital, submitted the pre-authorisation request, and the insurer approved the cost within 4 hours. Post-surgery, Vinay only paid ₹2,000 for non-medical items.

Case 2: Reimbursement Woes

Sana had to get her appendix removed urgently in a non-network hospital in her hometown. She paid ₹1.8 lakhs upfront and submitted all bills for reimbursement. It took 40 days and two follow-ups to get her claim settled.

Pro Tips to Make the Most of Cashless Hospitalisation

• Know Your Network: Bookmark or save your insurer’s empanelled hospital list in India.
• Carry Your Health Card: Retain a digital copy on your mobile device.
• Read the Policy Document: Especially exclusions, co-pays, and room rent limits.
• Update Insurer on Medical History: Even post-purchase, you can notify them of recent changes.
• Track TPA Cashless Approval Time: It is advisable to follow up if approval is delayed beyond six hours.

Why RenewBuy is the Right Platform for Your Health Insurance Needs

When it comes to choosing a health insurance plan, having access to multiple options from trusted insurers and being able to compare them side by side is a major advantage. This is where RenewBuy stands out.

RenewBuy is a growing digital platform that gives you access to various health insurance plans from India’s leading insurance providers.

How Does RenewBuy Distinguish Itself?

• Access to Trusted Insurers: The platform has partnered with top IRDAI-approved insurance companies, giving you access to their entire catalogue of health plans (often with exclusive discounted premiums).
• Expert Guidance at Every Step: Over 1,25,000 trained advisors across 1,500+ cities are available to guide you through policy selection, explain policy terms clearly, and assist with claims when required. Customers may seek assistance via chat or phone or visit one of over 68 branch offices nationwide.
• Fully Digital Convenience: You can browse, compare, and buy policies online from anywhere. Instant premium quotes, policy features, and coverage details are all accessible through a few simple clicks.
• Customisation Options: Every policy at RenewBuy can be fine-tuned. Add riders, increase sum insured, or explore additional benefits like maternity cover or critical illness protection, all from the same dashboard.
• No Hidden Costs: RenewBuy offers complete price transparency. There are no hidden fees or surprise deductions during claims. What you see is what you get.

Conclusion

Cashless insurance concerns timely treatment, financial stability, and peace of mind. However, this safety net is effective only when its underlying mechanisms are clearly understood.

So next time you choose a health insurance plan, look beyond just premiums. Ask: How strong is their cashless hospital network? What is the average TPA cashless approval time? Is the policy structured in a way that supports you not just during claims, but before and after them?

As per IRDAI’s report (22-23), 56% of claims were settled via the cashless mode while 42% were processed as reimbursements. This means most people are missing out on one of the strongest features of modern health insurance.

Avoid becoming part of that statistic. Take charge, stay informed, and keep your health and finances safe.  
 

Disclaimer: The content published in this article is intended solely for the readers' informational purposes and should not be relied upon for personal, medical, legal, or financial decisions. It is advisable to seek advice from a qualified professional regarding specific concerns. The details provided regarding the plan are for reference purposes only. Please visit the insurer’s website for the latest updates on the plan. The company does not guarantee suitability, reliability, timeliness, or accuracy of the information, services, or any other aspects mentioned in this regard for any purpose. We do not endorse any insurance company or insurance product provided by any insurer.