What's inside? 🧐
- Introduction
- Let's first begin by understanding health insurance claims
- What is a network hospital?
- What are the advantages of network hospitals?
- How to go about availing cashless claims at network hospitals?
- How can you find network hospital in your vicinity?
- Important Note
- Wrapping up
Introduction
In an ever-changing world full of uncertainties, it's easy to get caught off guard by life's unexpected twists and turns. As diseases continue to increase, prioritising your health has never been more crucial. Health insurance serves as a reliable shield, providing valuable protection against skyrocketing medical expenses that can leave you feeling vulnerable. If you're currently researching and trying to understand health insurance, you may have come across the term "network hospitals" and wondered what it means. Network hospitals play a pivotal role in the healthcare ecosystem, offering a multitude of benefits to individuals and families alike. Network hospitals that your insurance provider partners with can help you gain access to a wide range of medical services and specialists, ensuring comprehensive and timely care.
In this article, we'll explore the concept of network hospitals in more detail and provide you with all the information you need.
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Let’s First Begin By Understanding Health Insurance Claims
While making a health insurance claim, there are two options available to you -
👉Cashless Claim
When you opt for a cashless claim, the insurance company directly settles your approved medical bills with the hospital where you receive treatment.
👉Reimbursement Claim
In a Reimbursement Claim, you are required to pay the medical expenses upfront and then seek reimbursement from your insurance provider.
As you consider these two options, it becomes clear that opting for a cashless claim is the way to go. After all, medical expenses can easily spiral into daunting figures! With a cashless claim, you need not worry about arranging for funds and the hassle of dealing with documentation. The insurance company and the hospital take care of all the necessary paperwork, leaving you free to focus on your well-being without any added stress.
Now the question is, how can you avail a cashless claim? This is where network hospitals come in.
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What Is A Network Hospital?
A network hospital is a selected hospital that your health insurance company has a tie-up with. This means that you can get treatment there without having to pay upfront. The insurance company or their third-party administrator (TPA) will provide a list of network hospitals to make it easier for you to make cashless claims. Insurance companies and hospitals essentially form an agreement to offer you, the customer, cashless facilities.
The contract provides detailed instructions outlining the steps that both the insurer and the hospital must adhere to in order to efficiently process claims. It will also include pre-agreed prices for different treatments.
Basically, the contract will cover -
- The documents that are sent to the insurance company for approval from the hospital.
- The specific documents that need to be sent.
- How long will it take for the insurer to process cashless requests, etc.
- The agreed prices for different treatments.
Now that we have a fair idea of network hospitals, let's explore their advantages.
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What Are The Advantages Of Network Hospitals?
The process of settling claims at a network hospital is easy.
👉Direct Bill Settlement
If your insurance company agrees to the cashless settlement at the network hospital, they will pay the hospital bill directly. You will only need to pay for expenses that are not covered by your policy, such as consumables, administrative fees, registration fees, etc.
👉Less Paperwork
Another great benefit is that you don't have to worry about lots of paperwork. The hospital's cashless desk handles all the necessary documents for you and shares them with your insurer, like discharge summaries, prescriptions, indoor case papers, etc.
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How To Go About Availing Cashless Claims At Network Hospitals?
Let’s understand the process of availing cashless claim at a network hospital -
👉Availing Pre- Authorisation
If you intend to get hospitalised in a network hospital and choose a cashless claim, inform the insurance company about your hospitalisation. They will give you a pre-approval called "pre-authorisation" through your hospital.
When it comes to planned hospitalisation, it is of utmost importance that you keep your insurer informed. By notifying them in advance, you will ensure a seamless pre-authorisation process, which must be completed before your admission.
For emergency hospitalisation, like in the case of injuries from a road accident, ensure that the hospital's cashless desk sends a claim intimation to your insurance company.
👉Final Bill Settlement
Once your discharge date is confirmed, the hospital insurance desk/TPA will send the final bills and necessary documents to your insurer. The insurer will review and approve them and settle the payment directly with the hospital.
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How Can You Find A Network Hospital In Your Vicinity?
The health card, which is a physical or digital card that you receive from your insurance provider, typically includes a list of network hospitals. You can also easily find this information on their website. To determine if your hospital is included in the insurer's network hospital list, simply follow these steps:
- Visit your insurer's website to begin the process.
- Enter your city name or pincode in the search bar on the website.
- Type the name of your hospital in the search bar as well.
- If the hospital is listed with your insurer, you will find its name on the provided list.
- You can also call the insurer toll-free and get the necessary details.
Here is a table that will help you find the Network Hospitals present in your vicinity:
Health Insurance Company | Network Hospital Link Aditya Birla Health Insurance Co. Ltd. | https://www.adityabirlacapital.com/healthinsurance/locate-care/hospital-listing Care Health Insurance Co. Ltd | https://www.careinsurance.com/health-plan-network-hospitals.html Manipal Cigna Health Insurance Co. Ltd | https://www.manipalcigna.com/locate-us Niva Bupa Health Insurance Co. Ltd | https://rules.nivabupa.com/hospital-network/ Star Health & Allied Insurance Co. Ltd. | https://www.starhealth.in/lookup/hospital/ Acko General Insurance Co. Ltd. | https://www.acko.com/p/health/networkhospitals Bajaj Allianz General Insurance Co. Ltd. | https://www.bajajallianz.com/branch-locator.html Cholamandalam MS General Insurance Co. Ltd. | https://www.cholainsurance.com/cashless-hospitals Future Generali India Insurance Co. Ltd. | https://general.futuregenerali.in/hospital-locator Go Digit General Insurance Co. Ltd. | https://www.godigit.com/health-insurance/digit-cashless-network-hospitals-list HDFC ERGO General Insurance Co. Ltd. | https://www.hdfcergo.com/locators/cashless-hospitals-networks ICICI LOMBARD General Insurance Co. Ltd. | https://www.icicilombard.com/cashless-hospitals IFFCO TOKIO General Insurance Co. Ltd. | https://www.iffcotokio.co.in/contact-us?tab=hospital Kotak General | https://www.kotakgeneral.com/network-locator/hospital-network Liberty General Insurance Co. Ltd. | https://www.libertyinsurance.in/products/CPMigration/hospitalLocator Magma HDI General Insurance Co. Ltd | https://www.magmahdi.com/more/contact-us?f=y National Insurance Co. Ltd. | https://nationalinsurance.nic.co.in/en/health-insurance/city-wise-list-ppn-hospitals Navi General Insurance Co. Ltd. | https://navi.com/insurance/network-hospitals Raheja QBE General Insurance Co. Ltd. | https://www.rahejaqbe.com/hospital-locator Reliance General Insurance Co.Ltd | https://rgi-locator.appspot.com/?Search_by=hospital&sourcesystem=website&phonenumber=&emailid=#/ Royal Sundaram General Insurance Co. Ltd. | https://www.royalsundaram.in/health-insurance/cashless-hospitals SBI General Insurance Co. Ltd. | https://www.sbigeneral.in/contact-us/hospital Shriram General Insurance Co. Ltd. | NA Tata AIG General Insurance Co. Ltd. | https://www.tataaig.com/servicing/locator/hospital-locator The New India Assurance Co. Ltd. | https://www.newindia.co.in/portal/locateUs The Oriental Insurance Co. Ltd. | https://orientalinsurance.org.in/en/web/guest/network-hospitals?isSelected=locator&isRefresh=true United India Insurance Co. Ltd. | https://uiic.co.in/en/tpa-ppn-network-hospitals Universal Sompo General Insurance Co. Ltd. | https://www.universalsompo.com/cashless-hospitals/Locate-branches Zuno General Insurance Co. Ltd. | https://www.hizuno.com/cashless-hospital-network
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Important Note!
Network hospitals will not be on your insurance company's list forever. It's up to the insurer to decide whether to remove a hospital from their network. The same goes for hospitals, as they can choose to leave the signed contract at any time.
Insurers may stop offering cashless services at a particular hospital if there have been fraudulent claims or repeated violations of the contract terms, among other reasons. On the other hand, you may encounter hospitals that do not accept cashless claims, even if they are listed with your insurer. This could be due to reasons such as frequent delayed payments from the insurer, excessive negotiations regarding payments, etc.
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Wrapping Up!
Now that you have learned how to check the network hospitals of your insurance company in India, you can take control of your healthcare journey with confidence. By following the step-by-step process outlined earlier, you can easily access a comprehensive list of network hospitals and make informed decisions about your medical needs. Remember to regularly update yourself on any changes or additions to the network, as this will ensure that you receive the best possible care and maximise the benefits provided by your insurance policy.
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