‘Network Hospitals’ is a popular term that we come across when we purchase a health insurance plan, but very few understand what exactly it is and what it entails. Here, we throw light on its meaning and various other aspects of it.
Defining Network Hospitals
It is a common knowledge that hospital charges of a private hospital are far higher than a government one. Moreover, private hospitals inevitably charge a higher bill from patients who have an insurance cover compared to the ones who lack the protection cover. This directly means that insurance companies would need to pay more than is a huge loss for them.
To avoid the pitfall, insurance companies form an agreement with few hospitals. It not only brings the costs down for the insurance companies but facilitates offering cashless treatment in these hospitals to its policyholders. This chain of hospitals with whom an insurance company has entered into an agreement are referred to as network hospitals.
You find this list of network hospitals provided with your policy. You can also find the list published on the website of the health insurance provider.
Difference Between Network and Non-Network Hospitals
The major difference between the two is the benefit of cashless treatment. You can avail cashless treatment in all network hospitals as the insurance provider has an agreement with them. The bill is settled directly between the hospital and the insurance company.
But if you get admitted to a non-network hospital; you would first need to bear the entire cost of treatment from your own pocket. Then, you would need to submit all invoices and medical reports with your insurance provider for claiming reimbursement.
The insurance company may fully or partially reimburse your claim. For instance, it may state the room charges as higher than the market rate and make only a partial payment for it.
Who wins?
The above facts make it evident that network hospitals is the best option for any policyholder. It eases plenty of financial burdens of you. Thus, it is always wise to check the list of network hospitals and track a couple of them near to your location. If you need emergency hospitalization, you can easily get admitted to any of the network hospitals and avail cashless treatment or highly reasonably-cost treatment.
Sometimes, you have a pre-planned hospitalization. In that case, you can contact the TPA and get all pre-approvals beforehand and then get admitted to the hospital for the treatment. You should choose a non-network hospital only when you have no other options left.
Steps to Make a Cashless Claim at Network Hospitals
Here, we walk through the steps of making claims at network hospitals for both planned and unplanned hospitalization.
- Planned hospitalization
Here, the insurer plans for hospitalization well in advance. For instance, you might be getting hospitalized for surgery, etc. In this scenario, you must first show your company-issues health insurance card and procure a pre-authorization form from the hospital. You can also download it from the insurer or the TPA’s website. The TPA is the third-party administrator who acts on behalf of both the insurance company and the insured individual.
The form is filled by both the insured the physician who is attending the patient. The completed form is then submitted at the insurance desk of the hospital where it is verified for complete information and proper fill-up. The form is then handed over to the TPA who in turn submits it to the insurance company. The insurance company reviews all facts and approves an amount for the treatment. The authorization letter is then sent to the TPA who passes it to the insurer.
The insurer is now required to show both the health insurance card and the authorization letter at the time of hospitalization. You can then relax as the medical expenses are now settled directly between the insurance provider and the hospital.
- Emergency hospitalization
This is a situation where you are not prepared for hospitalization like that in an accident. Here, you get admitted by merely showing your health card. Within a few hours of hospitalization, the pre-authorization form is collected, duly filled in and then submitted to the TPA who moves the process of getting approval from the insurance company.
Often the insured person is not in a state to complete the form. In that instance, it is filled by his/her relative. The hospital also issues an emergency certificate to justify emergency admission. Usually, the hospital desk fast-tracks the entire process for the cashless claim. The normal time for the approval for cashless treatment to come through is six hours. But it can get delayed. In that scenario, it is advised to pay for the treatment and claim for reimbursement later.
Wrapping up
The benefit of getting into a network hospital is immense for any policyholder. The only point you need to remember is you must always carry your cashless treatment card with you at all times to make use of it whenever required.
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