Understanding the Role of Network Hospitals in Health Insurance
With healthcare costs continually rising, failing to obtain health insurance is a significant error. When at the hospital, it has frequently been seen that patients who cannot afford the care take loans to pay for it. Health insurance is the only method to avoid such a situation from occurring at all. With health insurance, one can access cashless services at network hospitals in addition to affordable, high-quality healthcare. This means a person can receive the necessary medical care without paying for it at the hospital.
A hospital is referred to as a network hospital if it agrees with an insurance provider to offer cashless care. This article clarifies the cashless health insurance claim for hospital admission at a network hospital.
The Meaning of a Network Hospital
The hospitals partnered with insurance companies offer policyholders the perk of a cashless stay at the hospital. In this scenario, the policyholder does not need to rush to raise the money. Instead, the health insurer will pay all hospital fees upfront. An individual will receive a list of network hospitals from the insurance provider when he/she purchases a health insurance plan. The health insurance company's website also has a copy of this information or the list of hospitals.
The Function of Network Hospitals in Health Insurance
If you have cashless health insurance, the right place to receive medical care is one of the network hospitals of your choice. Every city has several network hospitals, so choose the one that best suits your needs based on location, quality, price, etc. It is advisable to identify the network hospital in advance so that you will not lose time trying to choose the hospital in the event of an emergency. Make a thorough analysis of your city's network hospitals and select the ideal one for your requirements.
How Do Network Hospitals Operate?
The patient must submit documents to TPA after being admitted to a network hospital to be eligible for cashless treatment. These documents include - health insurance card, identity proof, etc. The patient is allowed to receive treatment at the hospital upon validation of the cashless claim. Upon discharge, the patient does not need to make any payments because the insurance company will cover all hospital costs up to the sum insured limit. Non-admissible expenses, if any, will get reimbursed by the company. There won't be any paperwork or waiting period for the patient to submit, either. However, the insurer doesn't pay for any expenses not listed in the policy agreement.
Network hospitals play a role in two scenarios - a patient's scheduled hospital stay and the need for unanticipated or emergency hospitalisation. Let's examine how network hospitals function in these two scenarios:
Schedule Hospitalisation - You can easily take advantage of cashless hospitalisation at nearby network hospitals if you plan when and how long you'd need to be admitted for specific therapy. The hospital would ask you to complete a pre-authorisation form during admission. With the help of this form, the insurance provider's consent is requested to start the patient's cashless treatment.
You can present this form for approval at the hospital's insurance counter. If it is accepted, your insurer will let the hospital know so that the treatment can start without you having to pay anything. Pre-authorisation needs to be done at least 2-4 days before the admission, subject to the policy’s terms and conditions.
Emergency Admission - This case also follows the same procedure for requesting approval using the pre-authorisation form, allowing smooth beginning of the patient’s therapy. However you have about 24 hours to do so from the time of hospital admission.
The Selection Process for Network Hospitals
Each hospital chosen for empanelment by your insurance has undergone a rigorous background investigation. In addition, each hospital undergoes evaluations to determine its effectiveness and level of knowledge in providing the specific services it offers. The insurance provider may periodically modify or renew its network of hospitals based on these criteria. If a particular hospital in the insurer's network does not provide top-notch care, it will be taken off the list.
How Can You Choose a Suitable Network Hospital?
Finding suitable network hospitals may seem like a difficult procedure, but that is not the case at all. Finding the best network hospital is a straightforward process. First, compile a list of all network hospitals in your city using the insurance provider's website or the policy paperwork. If you can't locate it online, call your insurance company immediately and ask it to share the list of network hospitals in your region. Once you have the list in your hands, thoroughly investigate each hospital on it, considering factors such as proximity to your home, amenities offered, medical team, cost, reputation, reviews, etc.
The Benefits of Network Hospitals
There are various benefits of network hospitals in terms of health insurance. Some of them include -
Cashless Claims - A customer may submit a cashless claim to obtain insurance coverage. Cashless claims are put into motion when the insured person notifies the insurance company that they have incurred medical expenses. The business then establishes a direct line of communication with the hospital and handles the medical bills there. Cashless claims are only allowed if the patient informs the insurance provider of his illness right away after getting admitted to the hospital in case of emergency admission and about 2-4 days before a scheduled admission.
Easy Decision - Since insurance companies already provide network hospitals, selecting one during hospitalisation is no problem because the insurance policyholder might have previously visited the hospital for routine check-ups and prescription renewals for their medication or enquired about it.
Service without Complications - The entire hospitalisation process is hassle-free and simple when network hospitals are available. Due to the patient's hospitalisation and subsequent receipt of medical care, the insurance provider would not point to any issues with claims.
Conclusion
Network hospitals offer quick medical care with no waiting period or hassles with paperwork and bill submission. The insurance provider pays the sum directly, so the patient is not charged for medical expenses at the network hospital. Besides saving time, it also eliminates the hassle of double-checking bills before paying them. It is advised to pick a cashless hospital in advance to avoid delays when receiving urgent care.
Read more - Here are a Few Differences Between Network and Non-Network Hospitals
The main benefit of seeking care at a hospital in the network is that the insured does not need to struggle to locate funding because the insurer will cover all expenses.
Insurance firms maintain networks primarily to manage and anticipate costs. For example, insurance companies establish networks where doctors consent to a discounted payment rather than paying a doctor's bill for a specific treatment.
It refers to a hospital or another healthcare unit tied up with the insurer.
Third-party administrator. The health insurance company's agent is a TPA. It serves as a liaison between the insured party and the insurance company. Its primary responsibility is to handle all insurance and cashless claims related to hospitalisation and medical costs.
Some insurance companies offer a "cashless hospitalisation" service that enables policyholders to use hospital services without being concerned about settling hospital bills.