Insurance Cashless vs NBFC-Supported Cashless: What Hospitals Should Know

Both models can keep treatment cashless for the patient. The important difference for a hospital is when it receives payment and who manages the insurance follow-up.

The journey every hospital knows: insurance company cashless

In the traditional insurance cashless model, the hospital submits a pre-authorisation request to the insurer or TPA. Treatment proceeds against the approved amount, with enhancement requests if costs rise. At discharge, the final bill and supporting documents are submitted for final approval.

Queries, clarifications or additional document requests may follow. The claim is assessed against the applicable package rates and policy terms, and deductions may apply where relevant. The hospital receives payment after the insurer processes the settlement.

The patient may leave without paying the covered amount, while the hospital carries the receivable until settlement.

The five hidden costs of waiting

1. Payment timelines: The hospital has delivered care and incurred costs, but settlement may take time. Pending claims can tie up working capital.
2. Package rates: Claims are assessed against applicable package rates, which may not always match the hospital's current costs.
3. Deductions: Policy terms, sub-limits and non-payable items can reduce the final settled amount compared with the billed amount.
4. Discharge delays: If final approval is pending, discharge may be delayed, affecting bed availability and the experience of patients and families.
5. Staff bandwidth: Billing teams may spend time responding to queries, resubmitting documents and following up with TPAs.

For smaller and mid-sized hospitals, delays can affect working capital, supplier payments, staff payments and plans for growth.

How NBFC-supported cashless works with E-Mark Healthtech

In the NBFC-supported model described here, a regulated financing partner pays the hospital bill on the day of discharge for an eligible insured patient, as per the agreement with the hospital. The financing partner then takes on the recovery process linked to the insurance claim.

• For the hospital: The bill for an eligible insured patient is settled directly on discharge day, according to the hospital partnership agreement.
• For the claim: E-Mark Healthtech coordinates the claim process, including documentation and follow-up through final settlement with the insurer.
• For the patient: The article's described arrangement states that the patient repays after the insurance claim is credited, with 0% interest and zero processing fee, subject to eligibility and applicable terms.
• Policies covered: The model is described for both cashless and reimbursement policyholders.

The insurance claim still takes place. The difference is who carries the wait for its settlement: the financing partner rather than the hospital, under the agreed arrangement.

At a glance: what changes for your hospital?

The two models are not necessarily rivals. Insurance cashless remains the insurance coverage mechanism. NBFC-supported cashless adds a financing arrangement that can change when the hospital receives payment and who handles follow-up.

Before you sign: six questions to ask any partner

1. When exactly is my hospital paid? On discharge day or after additional processing?
2. Which patients and policies are covered? Cashless only, or reimbursement policies too?
3. What is excluded? Ask about non-medical items, co-payments and patient eligibility checks.
4. Who handles queries and rejections? Will the hospital billing team still need to follow up with the TPA?
5. What is the commercial structure? Understand the fee in writing and compare it with the operational cost of delayed payments.
6. What is the partner's track record? Ask how many hospitals and claims they have handled, and verify the lending entity's regulatory status.

A reliable partner should explain these points clearly and in writing before the hospital signs an agreement.

The real question: who should carry the wait?

Insurance cashless addressed the patient's payment experience at the billing counter. NBFC-supported cashless is designed to address a different challenge: the hospital's wait for payment after care has been delivered.

For hospitals where delayed settlements affect cash flow, bed turnover and staff time, the important question is how the payment process is structured and who carries the receivable during the claim cycle.

E-Mark Healthtech's supplied article states that it works with 300+ partner hospitals and has processed 2,500+ claims. Hospitals should discuss the service scope, eligibility, commercial terms and settlement process directly with the team.