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What are Network Hospitals in Health Insurance?

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Imagine yourself in a medical emergency, seeking immediate treatment at a hospital. Amid the stress and urgency, the last thing you want to worry about is arranging the necessary funds to cover your medical expenses. This is where your health insurance plans come into the picture, especially if it has a huge network of hospitals. By learning the ins and outs of network hospitals and cashless claims, individuals can access quality healthcare without the immediate financial burden, thereby ensuring timely and appropriate medical treatment for themselves and their loved ones.

What are Network Hospitals?

Every insurance company has a tie-up with some hospitals across the country which provide cashless treatments to its policyholders. These hospitals are called network hospitals. When you get admitted to a network hospital for treatment, the insurance company will directly settle the bills with the hospital, subject to the terms and conditions of the health insurance plans. You don’t have to stress over paying the hospital bills upfront, whether in case of a planned hospitalisation or emergency. So, when buying health insurance plans, one of the crucial factors to consider is the list of network hospitals. An insurance company with a wide network of hospitals will ensure you receive timely and best possible treatment and care without worrying about the cost. The insurance provider will take care of the medical expenses incurred up to the sum insured. It will also save you from going through the entire process of submitting bills and other documents to get your claims reimbursed after discharge.

Example

Everything was going smoothly for Sheena, a working professional, until one morning, she got up with unbearable chest pain. She was rushed to the nearest health insurance network hospital and had to undergo surgery for her blocked arteries. The treatment cost came to Rs 5,50,000, which her insurer paid. She had to pay only the deductible amount from her pocket. Since there was no financial burden on her to pay the entire hospitalisation cost, she could focus on her recovery. Now, if she had been admitted to a non-network hospital, she would have had to pay the entire bill amount and then get reimbursed after discharge. Having the best health insurance in India saved Sheena during the medical crisis.

How to make a cashless claim at a network hospital?

Here are the steps to follow to avail of a cashless claim at network hospitals:

• Present the health insurance card or policy number at the hospital’s insurance desk. In case of planned hospitalisation, you have to submit your doctor’s recommendation for hospitalisation and other required documents.

• Ask for a pre-authorisation form from the insurance desk, or you can download the same from the website of the insurance provider or TPA (third-party administrator).

• Fill up the necessary details required and submit the form at the insurance desk.

• The insurance desk will pre-authorise the details and send the cashless claim request to the TPA or insurance provider.

• Once the claim request is approved, you will receive an SMS or email confirmation on your registered mobile number or email ID.

• In case of planned hospitalisation, you have to present the approval mail/SMS to the hospital on the day of admission.

• At the time of discharge, the insurance provider will verify all the details and settle the bill directly with the hospital.

• If it is an emergency hospitalisation, you have to inform the insurer within 24 hours of getting admitted to a hospital.

Conclusion

One of the benefits of having health insurance plans is cashless treatments, which a policyholder can avail of only in network hospitals. During a medical emergency, health insurance network hospitals are a saving grace because you don’t have to worry about arranging money at the last moment as the insurance provider will directly settle the bills with the hospital. While buying the best health insurance in India, look for an insurance provider with a vast network of hospitals and check if there are any network hospitals in the vicinity of your home. Also, keep the list of hospitals handy to rush immediately in an emergency. Due to the rising medical costs, health insurance plans have become a necessity to save your finances from getting drained in paying hospital bills.

Disclaimer : The above information is for illustrative purpose only. For more details, please refer to policy wordings and prospectus before concluding the sales

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