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All You Need to Know About Network Hospitals Under Health Insurance

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Ram is a family man in his mid-thirties. He resorts to an active lifestyle with daily morning walks and taking fitness lessons. Despite his healthy lifestyle, one afternoon, he has immense chest pain and rushes to a nearby hospital. The doctors discover that it is a mild case of cardiac arrest. Due to timely actions, he receives medical attention at a reputed medical facility.

health insurance

When it is time for paying the hospital bills, his family remembers that particular medical facility is among the network hospitals in their health insurance policyThis brings a big sigh of relief as the treatment cost is settled via cashless mode.

What are network hospitals?

Most insurance companies have affiliation or tie-up with a list of hospitals around the country. Availing treatment from these network hospitals is a hassle-free and cashless experience. The policyholder need not worry about making arrangements for finances to repay the medical bills. The insurance company directly settles the expenses of hospitalisation with the medical facility.

What is the benefit of availing treatments from a network hospital?

The primary advantage of availing treatment from a network is relief from arranging money at the last moment. Health contingencies are uncertain, and an unexpected ailment can disturb your financial plan. When an insured opts for a cashless facility under their health cover, the insurer settles the medical bills if admitted to one of the network hospitals. It takes off the financial pressure on the family or the insured themselves to repay the heft cost of treatments. Also, there is no compromise on the quality of treatment as these network hospitals are shortlisted by the insurer for its standardised and quality procedures.

What is the process of filing a claim at a network hospital?

There are two scenarios for filing a claim. Either it is a case of planned hospitalisation or a medical emergency.

In case of planned hospitalisation, the insured individual books an appointment at any of the network hospitals. Next step is informing the insurance company. Here the insurer requests for a pre-authorisation form which can be availed from the hospital or downloaded from the insurance company’s website. This form is required to be submitted at the network hospital, which will then forward to the insurance company. The insurance company will either approve or reject the treatment as per the terms of the insurance policy. On the day of admission to the hospital, the insured needs to provide the identification card issued by the insurance company. Once the approval is received, all expenses will be directly settled by the insurance company

An emergency hospitalisation generally occurs when an illness that requires immediate medical attention or the policyholder has met with an accident. The claim process must be initiated within 24 hours of admission. The health card issued by the insurance company needs to be shown at the hospital. Moreover, the pre-authorisation required by the insurance company needs to be processed within a few hours of hospitalisation. Note that the process for critical illness insurance plans may vary as they provide a fixed lump sum amount upon detection of the covered illness.

So whether you are availing individual or family floater plan, it is advisable to opt for treatment under the cashless mode at a network hospital. Seeking treatment at a network medical facility helps avoid all the hassles of claim submission and arranging money for the hospitalisation expense.

Lastly, don’t forget to use a health insurance premium calculator to compare the myriad policies that you can choose from. Stay insured and stay protected.


(Syndicated content)

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