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Health InsuranceJanuary 6, 2021

What is the importance of network hospitals in health insurance?

Life’s uncertainty has been on the rise lately. Everything under the sun has come under questions, especially our health, so we must make ourselves aware of the health insurance policies that have been offered by various insurance companies. For example, the rise of COVID-19 cases has seen a remarkable shift in people’s psyches as to understand the importance of health insurance policies and know better about them.

What is the importance of network hospitals in health insurance?

However, to avail the benefits of health insurance policies, it is also essential that we realise the importance of empanelled or network hospitals in health insurance. Because the network hospitals in health insurance will be more connected, and cashless claims and immediate transfer of money will be easier.

Let us first try to understand the meaning of network hospital? When we purchase a health insurance policy from an insurer of our choice, they provide us with a list of hospitals called Network Hospital. This list can be found on the policy document and the website of the company.

It means that during treatment, the patient does not have to run from one insurance company to another to avail the benefits. One can be in one hospital and avail cashless benefits for treatments to settle the payments. This is crucially important as the focus primarily is on saving time and effort to have more and more efficiency.

The next question can be about the proceedings related to the cashless claim at network hospitals. When we file for a cashless claim at the network hospital, three main parties are involved:

The insurance company, the hospital, and the insured person.

One can file an insurance claim under two main categories: Planned Hospitalisation and Unplanned Hospitalisation, which is the case of an emergency.

The critical difference between these two is that in the planned hospitalisation, the insurance company and the insurer are aware of the process of hospitalisation beforehand. All processes are kept under check before everything else like a process before availing the treatment.

The insured person or the family members need to fill a pre-authorisation form to get the person admitted. This form can be downloaded from the insurer’s website, and all details can be duly filled such that whenever a patient needs to be admitted, these details are always kept handy and even this form. This form may even be available at the hospital’s TPA or third party assistance counter. A TPA counter is a dedicated kiosk located within or near the hospital premises where all the insurers’ insurance-related queries and processes are addressed.

Once this form is filled, TPA starts the process of verifying all the details and all the requirements are assessed accordingly. This helps in building the trust factor of the company towards the insurer and vice versa. This trust factor plays a major role in this scenario because this form will be considered the most crucial and significant in the time of requirement. Once the insurer approves the claim request, an authorisation letter is sent by the insurer or the TPA to the hospital, stating the amount approved for the treatment performed.

This amount is directly settled with the hospital by the insurance provider for the treatment done. The approximate Turn Around Time (TAT) for pre-authorised claims in the case of network hospitals is approximately 30 minutes to 2 hours. However, it varies from hospital to hospital. The important advantage of network hospitals in health insurance is the fact that after fully filling all the details, the insurance company directly settles all the bills for the insurer.

This is a more hassle-free facility that health insurance companies provide. Also, cashless treatment is only possible in a network hospital and nowhere else. It also reduces a considerable amount of worry and tension for the insurer. The policyholder is not expected to pay any or all of the hospital bills as the insurer provides the same cashless claim. In a reimbursement claim, the policyholder has to pay all the hospital bills and then the insurer reimburses it.

The hospitals that enter into an agreement with the insurance companies to build network hospitals in health insurance provide a cashless treatment. Most hospitals now fall under this network as it has become increasingly essential to ascribe oneself into this category of the network hospitals in health insurance. Recently, hospitals and insurers have started to go into an agreement with regard to special treatments that can be given by hospitals like knee replacement.

These claims are also offered cashless for every case of hospitalisation. Such hospitals are part of the network hospitals or empanelled hospitals, and such an arrangement is known as preferred network hospitals or agreed network hospitals, and the claim is cashless. There can also be the presence of adverse possibilities, like a cashless claim, can be denied. It is important to observe when and how that is done. This situation arrives when the hospital sends information is incomplete or insufficient or if the ailment is not covered under the policy or if the request for pre-authorisation is not sent in time.

However, even if the cashless facility is denied, one can subsequently submit the reimbursement claim upon discharge from the hospital. It is important to carefully read all these details before submitting to any facility before acquiring the cashless benefit. If dealt unawares, it becomes difficult in the time of crisis to deal with the entire situation. In case of an emergency, the claim intimation must be sent to the insurance company within 24 hours. This provides a platform for no hassles while going for emergency treatment and then going for a lookout for financial help.

Prior intimation makes all things a lot easier and tension free. Some required documents include filling up claim form along with original discharge summary, doctors’ consultation report, and receipts in initial, investigation reports, self-declaration or an FIR are a must. Also, once the patient gets discharged from the hospital, the insurer settles the bill in case of a cashless claim.

While buying term insurance, it is essential to know the key differences and highlights of the policy you are aiming to buy. BimaKaro.in offers simple yet detailed research on different aspects of term insurance, so make sure you visit Bimakaro before finalising your purchase.

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