How Do Network Hospitals Work?
The insurance companies select the network hospitals based on thorough background checks, efficiency, and expertise of medical services offered. They renew their lists of network hospitals from time to time based on the quality of services they provide to the policyholders. This means that the tie-ups will not be renewed if the network hospital does not offer quality treatment.
The network hospitals selected by the health insurance companies offer cashless treatment to the policyholders. Cashless treatment can be availed for up to the sum insured limit and as per the terms and conditions of the policy.
Let us understand the role of network hospitals in two conditions:
1. Planned Hospitalization
In the case of planned hospitalization in a network hospital, you will require to fill a pre-authorization form and submit it at the insurance desk of the hospital. Wait for it to get approved or rejected. If it gets approved, then the Third Party Administrator or TPA (the service provider with which your insurer has partnered) or the in-house staff of the insurer will sanction letter to the hospital and the hospital can start with the treatment.
2. Emergency Hospitalization
In case of emergency hospitalization, the same process of filling the pre-authorization form and getting Third Party Administrator’s approval is carried out. The TPA has to accept or reject a claim within 6 hours. In case you do not have time, you can pay in cash and seek reimbursement later from the insurance company.
It is the responsibility of the insurer’s representative or a Third Party Administrator to coordinate with the network hospital and settle all the claims, be it cashless or reimbursement. They communicate it with the patient, the hospital, and the insurance company to process the request.
The non-network hospitals or the hospitals which are not listed as network hospitals by the insurance companies do not offer cashless treatment. To avail treatment in such hospitals, you need to pay first out of your own pocket and can request for reimbursement later.
Advantage of Network Hospitals
At network hospitals, you don’t need to pay even a single penny out of your pocket to the hospital and yet you can get good quality treatment. It is less worrisome.
Whereas in the case of non-network hospitals, you have to pay the entire amount out of your own pocket and make requests for reimbursement later. Your request only gets approved if the insurance company finds it reasonable. This means, there is a risk involved in that case. While purchasing a health insurance plan, make sure you choose a policy with the most number of network hospitals near you.
Let’s give us a call at our toll-free 7551196989 to know the number of network hospitals of a particular insurance company or compare different policies and get the best quote. At InsuranceDekho, we can also provide you with assistance after the policy is purchased.
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