A hospital that has an agreement with an insurance company for providing cashless treatment is referred to as a Network Hospital. This article sheds light on how one can go about making a cashless health insurance claim for admission in a network hospital.
With the constant rise in the price of healthcare, going without a health insurance plan is a big mistake. In the event of hospitalization, it has often been observed that those who are unable to afford the treatment, sometimes end up borrowing or taking loans. This in turn causes them to shell out more money (going beyond the hospital bills) as a result of interest on loans. The only way to prevent such an instance from arising, is through health insurance. With this product, not only can one afford quality healthcare, there is also the facility of cashless benefit one can enjoy at network hospitals. What this essentially means is that an individual can get the required medical treatment without having to pay for the same at the hospital.
What is a Network Hospital?
When an individual buys a health insurance plan, the insurance company will give him or her a list of network hospitals. This record i.e. the hospital list, can also be found on the website of the health insurance company. These hospitals have a tie up with the insurance company for the purpose of providing the insured the benefit of cashless hospitalization. Here, the policyholder does not have to run around making arrangements to raise the money. Instead, the health insurer will directly settle all the hospital bills.
How to make a Cashless Claim at Network Hospitals?
There are three entities involved in this process - the network hospital, the insurer/third-party administrator (who acts on behalf of the health insurer) and the insured individual.
- Planned Hospitalization: Here, the insured knows that he or she has to be hospitalized and books prior appointment at any of the network hospitals. To avail cashless hospitalization, the individual would first have to show the company-issued health insurance card and request for a pre-authorization form, which is available at the hospital or can be downloaded from the Insurer/TPA’s website.
Once the form is filled up by both the insured and the attending physician, it needs to be handed over at the insurance desk of the hospital. The person at the desk will verify its completeness and then send it to the insurer/TPA. The insurer/TPA will process the form and either approve or turn down the claim request, according to the terms and conditions of the health insurance policy. If the form is accepted, an authorization letter will be sent by the insurer/TPA, stating the amount approved for the treatment.
On the day of admission in the hospital, the insured has to display his or her health insurance card and the confirmation letter. The medical expenses will be paid by the insurance provider directly to the hospital.
- Emergency Hospitalization: This is when the policyholder meets with an accident or is suffering from an illness that requires immediate hospitalization. One generally needs to begin the claim process within a matter of 24 hours of hospitalization. The health card can be shown when the insured is brought in for hospitalization. The preauthorization request can be sent to the TPA within a few hours after admission. The documents that need to be submitted by the insured or a relative of the insured include - filled-up pre-authorization form and an emergency certificate (issued by the casualty medical officer) that justifies the emergency nature of admission.
The insurance desk at the hospital will fast-track the process for cashless claim. However, in the event that one cannot wait for the approval, it is recommended to pay the hospitalization expenses to begin the treatment and later claim a reimbursement. The time taken to process a cashless claim for emergencies is usually 6 hours.
Reimbursement Claim
If an insured is filing a reimbursement claim, then it is important that he or she collects each and every medical bill, mentioning the cost incurred during the treatment. After being discharged from the hospital, the individual needs to collect the Discharge Certificate or the Discharge Summary from the hospital. This has to be submitted along with the medical bills, reports and other related bills to the insurance company. The documents will be scrutinized by the insurer, and the insured will be reimbursed the medical expenses incurred, as per the terms and conditions of the policy.
Conclusion
To benefit from cashless hospitalization, it is important that the insured be admitted in one of the network hospitals of the health insurance company. Cashless claim is an excellent facility offered by health insurers as it spares one from any financial burden during hospitalization. Knowing that the hospital bills will be settled directly by the insurance company, the individual can simply focus all of his or her attention into recovery.
Before availing a health insurance plan it is recommended that one goes through the list of network hospitals of the insurance company. Those insurers should be shortlisted that have network hospitals listed close to residence. This way, commute will be much easier in the event that hospitalization is necessary.
