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Network Hospitals in Health Insurance
Sep 30, 2020

What Are Network Hospitals?

The rapidly increasing healthcare expenses have also increased the demand for health plans. A health insurance policy not only covers medical costs but also secures your loved ones. With a health plan, an individual can treat his/her illness with ease. Additionally, the health policies offer cashless benefits to the customers to ensure not a single penny goes out of their pocket. On the other hand, a policyholder can avail cashless hospitalization if they opt for a network hospital. Every insurance company has a list of network hospitals under their health insurance plans . Before customers buy health insurance, they must know what a network hospital is to avail cashless benefits. What are Network Hospitals? Every insurance provider has a tie-up with specific hospitals. When a policyholder purchases a health insurance plan, the insurance company gives them an option to select between the hospitals provided by them. This list of hospital alternatives offered by an insurer are called network hospitals. On selecting one of the network hospitals, a policyholder can make a cashless health insurance claim during medical emergencies. Bajaj Allianz General Insurance provides cashless health insurance facility at 6500+ hospitals across the country. The cashless claim procedure is easy to follow. However, there are three parties involved in the process: the insured, the network hospital, and the third-party administrator. Cashless Claims at Network Hospitals A policyholder can claim under two circumstances, which are given below:
  1. Planned hospitalization
Follow the steps given below for planned hospitalization:
  • Provide the hospital with a health insurance card from the insurer.
  • Request for a pre-authorization form or download it online from the insurer’s website
  • Submit the health insurance claim form to the hospital. After receiving the form, the hospital will get approval from the TPA or the insurer
  • Obtain the form from the hospital after the insurance company has approved it.
  • Give the confirmation letter and the health insurance to the hospital on the day of admission.
  1. Emergency hospitalization
Follow the steps mentioned below in the case of emergency hospitalization:
  • Submit the health insurance card
  • Request the insurer to send a pre-authorization letter after admission
  • Submit the relevant documents and an emergency certificate
Note: In case of a severe emergency, a policyholder must pay the hospitalization expenses from his/her pocket and claim reimbursement from the insurer later. A medical emergency requires special attention and immediate treatment. Amidst the chaos, it is impossible to wait for the approval from the insurance company. Hence, pay the expenses and claim for reimbursement, if the situation demands it. Reimbursement claim procedure:
  • Collect all the hospital bills and invoices from the hospital without fail.
  • Obtain the discharge certificate or the discharge summary from the hospital.
  • Submit all the medical reports, certificates, and other medical bills to the insurance provider. On obtaining the essential documents, the insurer will analyse it and process your reimbursement accordingly.
To sum up, cashless hospitalization is a great way to manage the financial burden of an individual.  It provides the policyholders with the right peace of mind during a medical contingency. Hence, a policyholder must select a good tie-up hospital to avail cashless settlement with ease.  

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  • Sachin. R. Haritay - February 28, 2021 at 9:40 pm

    How do we intimate the company as to the need for admitting the policy holder in a emergency situation ?

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