What Is A Cashless Network Hospital?

A cashless network hospital is one that has a tie-up with your insurance company to provide cashless treatments. Network hospitals are listed by the insurance company or its Third-Party Administrator (TPA), to provide cashless claims.

Essentially what happens is that hospitals and insurance companies enter into a contract to provide cashless facilities to all insurance customers. This contract will lay out all the steps the insurance company as well as the hospitals need to follow for claim processing. It will also contain details about the pre-agreed rates for various treatments and packages.

So, the contract generally includes -

1. The documents that will be sent from the hospital to the insurance company for cashless claim approval.
2. How these documents will be sent.
3. The time the insurance company will take to process the cashless request, etc.
4. The pre-agreed rates for various treatments carried out at the hospital.

What is Meant by Cashless Hospitalization?

Cashless hospitalisation, as the name suggests, means that when you get admitted to a network hospital (listed with your insurance company) for treatment, the hospital bill amount is settled directly with the hospital by the insurance company. You will have to foot only the non-payable expenses out of your pocket. For instance, consumables like gloves, nebulisers, etc.

The main advantage of cashless hospitalisation is that you don’t have to worry about arranging huge sums of money for the treatment. The costs will be handled directly by the insurance company.

Plus, you don’t have to run from pillar to post for documentation as all the documents will be communicated and exchanged between the insurance company and the hospital.

Cashless Claim Process

The cashless claim process is very simple and quick. You don’t have to arrange cash for the payment of hospital bills. If your insurance company approves your cashless claim, all bills will be directly paid by the insurance company or the TPA. And, all the paperwork including discharge summaries, prescriptions, indoor case papers, etc. will be submitted directly to the insurance company by the hospital.

However, there are a few hospitalisation-related expenses that aren’t covered by your health insurance plan. You will need to pay for them out of your own pocket. This may include consumable charges, administrative fees, registration fees, etc.

Here are the steps that you need to follow to file a cashless claim -

1. Contact the hospital’s insurance desk and inform your insurance company about the hospitalisation, recommended treatment, estimated cost of treatment, etc.
2. You will also need to provide some documents to the hospital insurance desk, so they can submit them directly to the insurer. Required documents include your health card, identity proofs, policy documents, etc.
3. The insurer will evaluate all the provided documents and provide a pre-authorisation for the eligible amount that can be paid. A pre-authorisation is essentially an initial promise that the insurance company will pay your hospital bills.
4. Following this, you can undergo the necessary treatment or surgery.
5. Before discharge, the hospital insurance desk will send your final bill to the insurance company. They will then evaluate the same and provide a final authorisation, after which the payment will be made directly to the hospital.
6. You will not be required to foot any approved expenses, they will be paid directly to the hospital by the insurance company.
7. Any expenses not approved will be reflected on your bill and you will be liable for them.