Cashless was denied. What now?

When a hospital asks your insurer to pay directly, it sends a pre-authorisation request. If that’s refused, you’ll be asked to pay. That isn’t the same as your claim being rejected.

Why cashless gets refused

• Missing papers, like doctor’s notes or test reports.
• The hospital isn’t in the insurer’s network.
• The insurer wants to check whether a condition is pre-existing.
• The treatment isn’t clearly covered, or a waiting period may apply.

What to do in the next 48 hours

• Ask the insurance desk for the denial letter and the exact reason.
• Send any missing documents and ask for a review.
• Call your insurer and note the request number.
• If you have to pay, keep every bill, receipt and report.

Then claim it back

You can still claim the cost after discharge. Most policies ask you to file within 15 to 30 days of discharge, with the original bills, discharge summary and reports. Check your policy for the exact window.

IRDAI rules ask insurers to decide on cashless requests within an hour and to approve discharge within three hours. If they don’t, ask the hospital desk to escalate.