Network Hospitals – Benefits, Role and Claim Process
Health insurance has become a necessity due to a significant surge in medical expenses. It works as a financial safety net during challenging times of medical crisis. Insurance companies offer a choice of hospitals in their network hospital list so you can get cashless treatment without paying money from your pocket. Moreover, with the cashless facility, you can avail quality treatment without worrying about arranging money at the last moment. Read the following sections to know more about network hospitals and their benefits.
What are Cashless Network Hospitals?
Every health insurance company has agreements with several hospitals to provide cashless treatment to its policyholders. These are called network hospitals and are an integral part of your health insurance policy.
Depending on the policy, your medical insurance company will provide cashless cover for hospital fees and expenses incurred before and after hospitalisation. This works only when you get treatment from a network hospital. Therefore, it is vital that you take note of the health insurance network hospitals in your vicinity.
How to Make Cashless Claims at Your Nearby Network Hospital?
Here is how you can make a cashless claim following a few easy steps:
1. Planned hospitalisation
- Find the nearest network hospital from the list.
- Download the pre-authorisation form from the TPA’s website. You can also find it in the network hospital’s TPA counter.
- Fill up the form and submit it to the insurer of your chosen network hospital.
- You will receive approval with the coverage details.
- Present your health insurance card or your policy number on the day of hospitalisation. Submit your authorization form along with it.
- Make sure that you submit the form within the time period of validity.
2. Emergency treatment
- Fill up and submit the pre-authorisation form within 24 hours of hospitalisation.
- The insurance desk stationed at the hospital will send your form across.
- The insurer will likely approve your claim within a few hours.
- Ideally, you should wait for the TPA’s approval. However, in case of urgency, you can pay the bills at that moment. Later, you can apply for reimbursement.
Documents Required for Making Claims at Network Hospitals
The various documents required to make claims during network hospital bill payments include:
- Duly filled and properly signed claim form
- Health card
- Medical certificates
- Valid ID proofs
- Hospital discharge summary
- All bills and receipts
- Test reports like blood tests
- In case of accident copy of an FIR
List of Day-Care Facilities That Can Be Availed at Network Hospitals
Day-Care procedures and facilities covered in network hospitals are:
- Eyes: Cataract surgery, foreign body removal from eyes, corrective surgery, tear duct surgeries
- ENT: Septoplasty, Tonsillectomy, Tympanoplasty, Myringotomy with Grommet insertion and foreign body removal
- Tongue: Incision, Excision, Glossectomy, destruction of diseased tongue and reconstruction
- Cancer treatment: Chemo and Radiotherapy
- Heart: Coronary Angiography
- Other Surgeries: Colonoscopy, Haemodialysis, Lithotripsy, Dislocation surgery, appendectomy and more
How do Network Hospitals Work?
Mentioned below are the points you should know to have a better understanding of how network hospitals work:
- A health insurance company checks the efficiency and expertise of medical services provided before collaborating with a hospital.
- Following this, they prepare a network hospital list and provide it to the policyholders.
- This list changes from time to time depending on the quality of service provided by these hospitals.
- Individuals covered under cashless insurance will have to submit a form to the Third Party Administrator (TPA) before getting hospitalised.
- In case of an emergency, the claim process can be started 24 hours after hospitalisation.
- The insurance company will cover the expenses mentioned in the insurance policy. You will only have to pay for services that the policy does not cover.
Benefits of Availing Treatment at Network Hospitals
In the present times, the importance of network hospitals has increased to a great extent. Given are some of the benefits of getting treatment at network hospitals.
- With network hospitals, you do not have to worry about losing valuable time.
- Your health insurance provider will cover all the medical expenses under the specified terms and conditions of the policy.
- Extensive bills will not weigh you down from getting quality treatment. Refer to your network hospital list to find a cashless hospital near your residence.
Role of Network Hospitals While Seeking Health Insurance
Network hospitals play a significant role while claiming health insurance benefits. It makes the process more convenient. Moreover, it will guarantee that the hospital will not overcharge the individual for the treatment and other hospital expenses. Network hospitals also ensure that the beneficiary gets the utmost comfort when they are hospitalised. The billing and mediclaim process also simplifies when one chooses to get treated from the network hospitals.
Also Read: Cashless Health Insurance Policy: Coverage Of Cashless Medical Insurance & Their Types
Differences between Network Hospitals and Non-Network Hospitals
A network hospital is registered under an insurer’s list of hospitals that provide cashless treatment. When getting treatment from a network hospital, you have to contact the TPA to get a letter of authorization. The insurance company will then bear the expenses so that you do not have to spend money from your savings.
Unlike network hospitals, non-network hospitals are not registered under the network hospital list of health insurance companies. So, if you get admitted to a non-network hospital, you have to pay the bills from your pocket.
Post-discharge, you have to submit the required documents. This involves a lengthy process of compiling and filing paperwork. The insurer will approve the expenses he/she finds reasonable. After a few days, the patient will receive the refunded amount.
Pre-existing Diseases in Health Insurance
An individual suffering from a medical condition before purchasing a health insurance policy is said to have a pre-existing disease (PED). It is rather difficult to claim health insurance for PEDs. Policyholders have to undergo a waiting period of 2-4 years to get coverage for a specified ailment.
On 10 February 2020, the Insurance Regulator and Development Authority of India (IRDAI) made significant amendments to the definition of pre-existing diseases.
As per the new clause, individuals who had their conditions diagnosed within three months of purchasing a health plan must be covered. Their conditions need to be registered on the pre-existing disease list.
Now your insurance policy can cover diseases such as asthma, diabetes, high blood pressure, thyroid, cancer, and more.
Exclusions of Services in Network Hospitals
The exclusions of services in cashless network hospitals are:
- Treatment or hospitalisation due to self-inflicted injury, self-harm, suicide, done when sane or insane
- Hospitalisation due to war or chemical or biological weapons/ exposure to radiation
- Hospitalisation due to alcohol or substance abuse
- Treatment and hospitalisation due to HIV/AIDs if not specified that the insurance is covering this disease
- Congenital diseases like mental disorders if not specified in the insurance policy
- Additional expenses like special diets and items of comfort and convenience
Also Read: Importance Of Cashless Hospitalisation: How Does It Work, Types and Benefits
Final Word
It is advisable to keep a list of network hospitals for reference in case you need to get hospitalised urgently. With cashless claims, you can get treatment easier and without much hassle. Get yourself health insurance from Navi App and free yourself from the burden of hefty hospital bills and concentrate on your recovery.
FAQs
Ans: The most important document you have to provide is your official health card. Apart from this, you have to provide one of the following as photo identification proof:
• Voter ID card
• Driving license
• Passport
• PAN card
• Aadhar card
Ans: Once your insurer receives all the required documents, they will check if you are eligible for a cashless claim. After the completion of the verification process, they will issue an authorization letter. This usually remains valid for 15 days.
Ans: It is advisable to begin the cashless claim request at least 5 days ahead of your hospitalisation. This way, you can save the time needed for paperwork and processing the pre-authorisation form.
Ans: The age of entry for health insurance policy differs with different policies and insurers. According to IRDAI’s regulations, all health insurance policies must have an entry age of at least up to 65 years. There are insurance policies that cover even older people.
Ans: Given are some tips to make sure that your cashless claim does not get rejected:
• Read the policy document to know all exclusions.
• Inform the insurer/TPA well before hospitalisation.
• Provide accurate information when filing claims.
• Keep the insurer’s contact details at hand.
Ans: These days many hospitals and insurers are entering into agreements for procedures like knee replacement. These types of agreements are called preferred or agreed-on network hospitals. As a beneficiary, the entire claim will be cashless for you. This is one of the major benefits of preferred network hospitals and additionally, the claim will be cleared faster.
Ans: Yes all medical insurance policies offer a list of hospitals when you buy that particular policy. These hospitals present in the mediclaim hospital list are called network hospitals.
Ans: In order to find the hospital list for your health insurance policy you need to follow the steps below:
Step 1: Visit the official website of your health insurance provider
Step 2: Click on the search for hospital tabs
Step 3: Select the state from where you bought the insurance
Step 4: Select the state and city from where you will be getting the treatment
After completing these steps you will be shown the list of hospitals that are covered in your health insurance policy.
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Disclaimer: This article has been prepared on the basis of internal data, publicly available information and other sources believed to be reliable. The information contained in this article is for general purposes only and not a complete disclosure of every material fact. It should not be construed as investment advice to any party. The article does not warrant the completeness or accuracy of the information, and disclaims all liabilities, losses and damages arising out of the use of this information. Readers shall be fully liable/responsible for any decision taken on the basis of this article.
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