Simply put: Network hospitals

Two friends meet over a coffee and the ensuing discussion moves towards network hospitals in health insurance. Shyam briefs his friend on why one should go for a network hospital if in a position to choose.

Shyam: For my recent hospitalisation to get an elective elbow surgery, I decided to add a network hospital to the criterion for short listing. Especially since I had the luxury of time on my side.

Sharon: Network hospitals are the list of hospitals at the end of health insurance brochure, right?

Shyam: Well, a little more than that I believe. Network hospitals are empanelled by the insurance provider and have a tie-up with them for financial transactions.

Sharon: By financial transactions you mean payments become easier with a network hospital?

Shyam: The complete opposite, in fact. You don’t have to pay. A network hospital allows you to execute a cashless transaction wherein the admissable treatment bill is cleared by the insurance provider without your involvement — provided you have that coverage limit to service the bill. Sure, discharge may get a bit delayed for processing, but it is satisfying to walk out hands free. With a plaster around my elbow in my case, but you get the point.

Sharon: So what happens if that were a non-network hospital?

Shyam: In a non-network hospital, you will have to claim a reimbursement from the insurer after paying from your pocket at the hospital. Imagine being in recovery from a procedure, and having to do a lot of to and fro with the insurer to get reimbursement. This can be easily avoided.

Sharon: Makes sense, the insurer should be able to better correspond with the hospital since both are large organisations with dedicated departments to execute the transaction. How does one ensure a cashless claim experience?

Shyam: For planned procedures, inform the insurer about your choice of network hospital as early as possible and vice-versa as well. The hospital or you can then generate a pre-authorisation and then you can get admitted for the procedure. At the time of discharge, the hospital gets the final clearance of the bills with the insurer and voila, you are done. Except for the non-surgical costs or exclusions, other bills are paid by the insurer.

Sharon: Sounds great, I would say that all hospitals should provide this facility.

Shyam: Well if IRDAI plans come to fruition, then all hospitals should end up within a common system, allowing for common empanelling.

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