Treatment at a Non-Network Hospital: How Reimbursement Works

Quick answer: If you are treated at a hospital outside your insurer’s network, you may still get cashless treatment under the Cashless Everywhere initiative by informing the insurer at least 48 hours before a planned admission, or within 48 hours of an emergency admission. If cashless is not possible, you pay the hospital and file a reimbursement claim with the original bills, reports and discharge summary.

Option 1: Cashless Everywhere

In January 2024, the General Insurance Council, together with general and health insurers, launched the Cashless Everywhere initiative. It aims to let policyholders receive cashless treatment even at hospitals outside their insurer’s network, on these conditions:

• For planned treatment, inform the insurer at least 48 hours before admission.
• For emergency treatment, inform the insurer within 48 hours of admission.
• The claim must be admissible under your policy, and the facility is provided as per the insurer’s operating guidelines.

In practice, whether cashless is granted at a particular non-network hospital depends on the insurer and hospital agreeing terms, so reimbursement remains a common route. Always ask early.

Option 2: Reimbursement claim, step by step

1. Inform your insurer or TPA about the admission as soon as possible, and note the reference number.
2. Pay the hospital and collect original bills and receipts.
3. Collect documents before leaving the hospital (see the list below).
4. Submit the claim form and documents within the time allowed by your policy.
5. Respond quickly to any query from the insurer.

Documents to collect before discharge

• Discharge summary
• Final itemised hospital bill and payment receipts
• Pharmacy bills with prescriptions
• Investigation reports and films or CDs
• Implant stickers or invoices, if used
• Doctor’s certificate or case notes if the insurer asks
• Your policy details, ID and bank details for payment

Our checklist on how to ask for an itemised hospital bill helps you get the right paperwork, and how cashless treatment works explains network hospitals.

Common reasons reimbursement claims are delayed

• Missing original bills or receipts
• No discharge summary, or one without a clear diagnosis
• Pharmacy bills without matching prescriptions
• Late intimation of the hospitalisation to the insurer
• Names or dates that do not match across documents

Tips for a smooth claim

1. Make a checklist of the insurer’s required documents and tick off each one before leaving the hospital.
2. Keep originals safe and send copies only if the insurer allows, keeping a record of what you sent and when.
3. Write the claim or intimation number on every page you submit.
4. Follow up in writing if you do not hear back, and keep all correspondence.

When you are treated far from home

Families travelling to another city should collect every document before returning, because getting missing papers later from a distant hospital can be slow. Ask the hospital’s billing desk for a final bill folder containing the itemised bill, receipts, discharge summary and reports, and check it on the spot.

If your claim is partly paid or rejected, ask for the reasons in writing and see why a claim may be only partly approved for next steps, including IRDAI’s Bima Bharosa grievance system.

How NEIMHAANS helps

NEIMHAANS is a non-clinical healthcare concierge that has helped families travelling for treatment since 2007. When families are treated away from home, we help inform the insurer early, check whether cashless may be possible at the hospital, and collect every document needed for a reimbursement claim before you leave the city. We do not sell insurance or give insurance or legal advice; your insurer, TPA or the scheme has the final word on coverage. See our services.

Frequently asked questions

This article is general information, not medical, legal, insurance or financial advice. Rules, schemes and hospital policies change, so always confirm details with your hospital, insurer or the relevant authority.