What Is A Cashless Network Hospital?

A cashless network hospital is one that has a tie-up with your insurance company to provide cashless treatments. Network hospitals are listed by the insurance company or its Third-Party Administrator (TPA), to provide cashless claims.

Essentially what happens is that hospitals and insurance companies enter into a contract to provide cashless facilities to all insurance customers. This contract will lay out all the steps the insurance company as well as the hospitals need to follow for claim processing. It will also contain details about the pre-agreed rates for various treatments and packages.

So, the contract generally includes -

  1. The documents that will be sent from the hospital to the insurance company for cashless claim approval.
  2. How these documents will be sent.
  3. The time the insurance company will take to process the cashless request, etc.
  4. The pre-agreed rates for various treatments carried out at the hospital.

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What is Meant by Cashless Hospitalization?

Cashless hospitalisation, as the name suggests, means that when you get admitted to a network hospital (listed with your insurance company) for treatment, the hospital bill amount is settled directly with the hospital by the insurance company. You will have to foot only the non-payable expenses out of your pocket. For instance, consumables like gloves, nebulisers, etc.

The main advantage of cashless hospitalisation is that you don’t have to worry about arranging huge sums of money for the treatment. The costs will be handled directly by the insurance company.

Plus, you don’t have to run from pillar to post for documentation as all the documents will be communicated and exchanged between the insurance company and the hospital.

Cashless Claim Process

The cashless claim process is very simple and quick. You don’t have to arrange cash for the payment of hospital bills. If your insurance company approves your cashless claim, all bills will be directly paid by the insurance company or the TPA. And, all the paperwork including discharge summaries, prescriptions, indoor case papers, etc. will be submitted directly to the insurance company by the hospital.

However, there are a few hospitalisation-related expenses that aren’t covered by your health insurance plan. You will need to pay for them out of your own pocket. This may include consumable charges, administrative fees, registration fees, etc.

Here are the steps that you need to follow to file a cashless claim -

  1. Contact the hospital’s insurance desk and inform your insurance company about the hospitalisation, recommended treatment, estimated cost of treatment, etc.
  2. You will also need to provide some documents to the hospital insurance desk, so they can submit them directly to the insurer. Required documents include your health card, identity proofs, policy documents, etc.
  3. The insurer will evaluate all the provided documents and provide a pre-authorisation for the eligible amount that can be paid. A pre-authorisation is essentially an initial promise that the insurance company will pay your hospital bills.
  4. Following this, you can undergo the necessary treatment or surgery.
  5. Before discharge, the hospital insurance desk will send your final bill to the insurance company. They will then evaluate the same and provide a final authorisation, after which the payment will be made directly to the hospital.
  6. You will not be required to foot any approved expenses, they will be paid directly to the hospital by the insurance company.
  7. Any expenses not approved will be reflected on your bill and you will be liable for them.

To select the best insurance for cashless claims, you need to check -

  • How many network hospitals the insurance company has.
  • If your preferred hospitals where you normally go for any treatment and the hospitals in your locality are listed as network hospitals with that insurance company

Network hospitals are the ones where you can make cashless claims. The biggest advantage of a network hospital is that you need not run from pillar to post to make financial arrangements for your treatment. The bill amount will be paid by the insurance company directly to the hospital. All you have to pay is some nominal charges.

The major difference between network and non-network hospitals is that network hospitals provide cashless claims. This means you need not worry about arranging for the treatment money as it will be taken care of by your insurance company. On the other hand, in non-network hospitals, you need to make the entire payment and then request for the claim reimbursement for the same after your discharge.

Insurance companies have network hospitals for providing cashless claims to make the claim process easy. Both the insurance company and the hospital enter into a contract that contains the procedure that the insurance company and the hospital will follow for processing the claim.

Having network hospitals also helps the insurance company establish customer loyalty as customers will prefer hospitals where the claim process is hassle-free.

Healthcare is defined as the organised provision of medical care to individuals or a community. Cashless healthcare refers to the treatment by a network hospital where the bill amount is paid directly to the hospital by the insurance company.

You can avail of cashless treatment at the hospitals that are listed with your insurance company. You can check if you are eligible for cashless hospitalisation with your insurance company as well as with the hospital at which you will be treated.

Once you are hospitalised, the hospital will raise a pre-authorization request with the insurance company. Once the approval is given by the insurance company, your treatment will be done on a cashless basis.

Currently, Care Insurance has more than 19000 network hospitals across India. Then -

  1. HDFC Ergo has more than 13000 network hospitals.
  2. Star Insurance has more than 13000 network hospitals.
  3. Aditya Birla has more than 10000 network hospitals.
  4. Niva Bupa has more than 8600 network hospitals.

The major benefit that network hospitals (listed with your insurance company) offer is a cashless facility. Network hospitals don't give you any discounts. When the claim is approved, the bill amount is paid directly by the insurance company by the network hospitals. However, hospitals do have some set rates with the insurance company/TPA which can save you some money.

No, getting admitted to a network hospital does not mean that your bill amount will be reduced. You will be charged according to the pre-decided rates between the hospitals and insurance company/TPA. But, you can avail of the cashless facility at the network hospital where you need not worry about paying the money from your own pocket.