Page 44 - Insurance Times November 2021

KNOW HOW NETWORK,

NON-NETWORK

HOSPITALS AFFECT

YOUR HEALTH CLAIM

T he pandemic has made it evident that How network hospitals work?

uncertainties will always find their way into our
The network hospital and the insurance company are
lives no matter how well-prepared we are. It is
informed about the hospitalization in advance in case of a
enough to make people realize that everyone is
planned hospitalization. Following that, the policyholder or
more exposed and vulnerable to deteriorating diseases,
his/her dependents have to file a pre-authorization form
irrespective of their age.
available at every hospital’s insurance desk to address
insurance and cashless claim related queries. You can also
Thus, knowing how expensive hospitalization and treatments
download and get the printout of the document from the
are, it is wise to buy a health insurance policy and to third-party administrator’s (TPA’s) website. After filling the
understand the role of hospitals, which play a crucial part in
form, the insured person is admitted.
settling claims. We often ignore the meaning of non-network
hospitals and network hospitals in health insurance until After submitting the form, the hospital will verify the details
someone gets hospitalized and a claim arises.
and notify your insurance company regarding the claim. Once
your insurance company approves the claim request, it will
Network hospitals vs non-network send an authorization letter to the hospital stating the
hospitals amount for the medical procedure. After that, the claim
amount is paid directly to the hospital by your insurer. This
When you buy a comprehensive health insurance plan, the
process takes approximately 30 minutes to 2 hours, depending
insurance company provides you with a network hospital list.
on the insurer.
Insurance companies and the mentioned network hospitals
have a tie-up that offers the policyholder the benefit of
cashless hospitalization. Effect on health claims
Now, let’s suppose the hospitalization is unplanned, and you
Amit Chhabra, head - health insurance, Policybazaar.com, are admitted to a hospital.
said that while getting treatment from a network hospital,
one doesn’t have to worry about making preparations for Case 1: When patient ‘A’ is admitted to a network hospital,
money at the last moment. The health insurer settles the the insurance company will take care of all the expenses, and
hospital bills directly, thereby taking the burden off the the patient can avail of the cashless claim facility with the
policyholder’s shoulders. help of a third-party administrator. ‘A’ will pay some expenses
for the components needed for the treatment, which are
“Whereas, if you choose to get the treatment from a non- not mentioned in the policy. After that, the documents are
network hospital, all the expenses will be borne by you at collected for other records.
that moment, and later you will get reimbursed for the same,"
he said. Chabbra said, “The insured need not pay a penny to the

44 The Insurance Times, November 2021