Have you ever faced any medical emergency in your family when you needed money to deposit in the hospital for the treatment of your family member but you didn’t have enough money in your hands? In such a scenario, you must have rushed here and there in search of an ATM and any friend who could give you the much-needed and immediate financial help.
Cashless Network Hospitals
While even thinking about such a situation can give you jitters, in the unpredictable life of today, it is best to be prepared for all such unforeseen urgencies. To avoid such instances, cashless hospitalisation has come into focus. Now, people have become more conscious of the new health policies of insurance companies. The insurance companies settle all the bills related to the hospitals without any trouble. The claim that is settled by the insurance companies depends on the limited amount covered under your chosen health insurance policy.
Cashless hospitalisation means that the beneficiary and his/her dependant family will not deposit any pre-admission charges in the hospital if any medical emergency arises. In this way, they don’t bother to think about the medical bills as their insurance company is accountable for settling their medical claims with the hospital directly. You only need to pay the uncovered expenses. But one thing that you should take care of is that the medical treatment should be done in the network hospital of that insurance company. Otherwise, you will not be able to get these benefits from your health insurance policy.
How Do Network Hospitals Work?
When the insurance companies sell their health insurance policies, they provide the list of the network hospitals to the policyholders. These network hospitals are those hospitals that have a tie-up with specific insurance companies for settling the medical claims of the policyholders. The medical insurance hospital list is updated by the insurance companies regularly. Hence, the policyholders should also keep themselves updated to avoid any kind of inconvenience in getting the facility of cashless hospitalisation.
Differences between Network and Non-Network Hospitals
While network and non-network hospitals may have a lot in common, they also have their own set of distinctions. When buying a health insurance plan, a better choice can be made if you know what these hospitals mean and how they can affect your health insurance claim. Here are some facts to outline the most significant differences between network and non-network hospitals.
Cashless claim facility is available. However, if need be, you can also choose the Reimbursement Claim facility.
No cashless claim facility is available. Only reimbursement claim after paying for the treatment out-of-pocket.
Only doctor’s advice for hospitalisation + identity proof of the insured and policyholder + health card/ policy document from the insurer. The rest of the documents are taken care of by the hospital.
All documents need to be submitted:
- KYC documents
- Health Card
- Doctor’s advice for hospitalisation
- Original bills and receipts
- Bank account details of the policyholder for the reimbursement claim.
Low, as only the portion not covered by insurance, i.e. consumables, deductible, co-pay, etc., would be needed to pay at the time of discharge. The rest of the expenses approved by the insurer would be settled directly by the insurer with the hospital.
High, as the entire hospitalisation expense must be borne first out-of-pocket, and then a reimbursement claim must be filed along with proper forms and documents. It takes about 60-90 days for the claim amount to get credited.
Quick as it needs to be settled within 2-6 hours at the time of discharge.
Delayed, as the claim needs to be filed within 10-15 days (TAT varies from insurer to insurer) and then another 60-90 days for the claim to get settled.
Role of Network Hospitals While Seeking Health Insurance
During the process of submitting a claim for health insurance benefits, network hospitals play an essential role. They streamline the procedure and make it easier to complete. In addition, it will ensure that the hospital will not charge the person an excessive amount for the treatment or any other hospital charges. When a beneficiary is admitted to a hospital that is part of a network, the hospital will guarantee that they get the highest possible level of comfort. When a patient decides to get treatment from one of the network hospitals, the billing and mediclaim procedure is further simplified.
Benefits of Cashless Hospitalisation
The policyholders should read all the guidelines given in the health insurance scheme to get the desired benefits in any kind of medical emergency. Some of the key benefits are given below:
- Since the claim will be settled by the insurance company, therefore, you don’t need to worry about the expenses of the medical treatment. Get all the necessary health care treatments to recover soon without any worry.
- No need to think about arranging the fund to deposit in the hospital. You and your family will get the cashless treatment. In case the cost of your treatment exceeds the predetermined limit of your health insurance plan, then you have to pay only the additional expenditure.
- The documentation process is handled by the hospital and the TPA desk. So you do not need to worry about the same.
Thus, check the network hospital list so that you know exactly which hospital to go to in case of any medical emergency wherein you can avail of the cashless claim.
How do you avail of the cashless hospitalisation facility?
You can avail of the benefits of the cashless hospitalization facility by following the two methods that are given below:
- Visit the network hospital that is tied up with your insurance company to get the cashless claim.
- Get the pre-authorization form from the hospital’s insurance department. This form is also available with the Third Party Administrator, also called TPA. You can download it from there easily.
- After filling out the form, submit it to the insurance department at the hospital.
- Then, the form goes to the TPA for verification procedure
- TPA verifies the form and informs the sanctioned cashless amount to the hospital
- You will get the pre-authorization form at the network hospital for the verification process.
- If you need treatment in an emergency, and can’t wait for approval from TPA, then you can settle hospital bills yourself. Later on, these bills will be cleared by the insurer.
Cashless Hospitalisation – Claim Process:
The claim is settled by the health insurance companies by following two methods:
- Step 1: Find a nearby network hospital from the health insurance hospital list.
- Step 2: Show your health insurance card and photo ID proof to get the pre-authorization form from the insurance desk.
- Step 3: Fill out that pre-authorization form correctly.
- Step 4: Wait for the final approval for the cashless hospitalisation from the TPA.
- Step 5: After the treatment, the documents related to the medical bills are verified by the insurance desk at the hospital
- Step 6: If the treatment cost exceeds the limit of the health insurance coverage, then the policyholder will have to pay that additional pocket.
- Step 1: Show your health insurance card along with photo ID proof at the network hospital.
- Step 2: Get the pre-authorization form correctly to get the Mediclaim.
- Step 3: If you can not wait longer for the approval of TPA, then the claim will be settled by the health insurance company as per the health cover amount decided in the health insurance policy after the treatment.
Documents required for cashless claim settlement:
The documents that are required for cashless claim settlement are given below:
- Get the pre-authorization/claim form to settle the claims
- Health card or policy documents
- Identity proof of the insured such as PAN or Aadhaar card
- If it is an accidental case, then the FIR is mandatory
The rest of the documents would be provided by the hospital such as:
- Discharge papers of the hospital
- Original documents such as medical consultation papers, diagnosis reports, medical prescription bills, etc.
- Original receipts of all investigations/ tests.
In fact, after the claim is settled, the original receipts are submitted to the hospital and only a duplicate copy of the same is provided to the patient party on discharge. However, if you wish to go for any further claim from a different insurer, then you need to collect a certified true copy of the same from the hospital.
Things to keep in mind when availing of cashless treatment at a network hospital:
The following important things should be known about cashless hospitalisation:
- For a hassle-free treatment and claim settlement, you should need to keep yourself updated about the medical insurance hospital list on the website of your health insurance company
- Keep all your documents related to the hospital with you safely for future reference
- Read all the terms and conditions given by the health insurance policy before buying it
- Each company has a different procedure for claim settlement. Follow your insurance company’s guidelines to settle the claim without any inconvenience.
- Don’t forget your health insurance card and photo ID proof at home. Keep it to yourself while visiting the hospital.
Every insurance policyholder should pay close attention to the network of hospitals in their area. It’s much better when you don’t have to run around arranging cash during medical emergencies. Seeking treatment at a network hospital makes perfect sense if you have a cashless mediclaim policy. Always stay updated with the health insurance hospital list, especially in your vicinity, in case you have to rush to one in an emergency.
This article is issued in the general public interest and is for educational purposes only. The blogs should not be used as a substitute for competent expert advice from a licensed professional to best suit your needs. Insurance is a subject matter of solicitation. For more details on policy terms, conditions, exclusions, limitations, please refer/read policy brochure before concluding sale.