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Network Hospitals

Network Hospitals Overview

Without health insurance, getting sick or injured could mean going bankrupt, going without needed care, or even dying needlessly’- Jan Schakowsky

Indeed!

With the surging healthcare costs, most of us buy health insurance plans as a means to reduce our medical expenses. Health insurance is a boon for people looking for quality medical treatment, as it frees them from worrying about hefty medical bills. Though the sum of money you spent from your own pocket would be reimbursed, you might have to bear the initial amount.

We found a way for you to put this concern to rest, and that is Cashless Claims. But, what are cashless claims?

A cashless claim is an option that states you are not required to pay for the medical procedure or treatment that is covered by your health insurance policy. Your insurance provider will compensate your medical bills directly with the concerned hospital.

This facility makes medical treatments more accessible and affordable, as you do not have to worry about paying a hefty amount of money during hospitalization as well as during the treatment. However, you can avail this facility only at partner hospitals or network hospitals.

What is a network hospital?

A network hospital is a hospital that ties up with your insurance provider and allows you to avail of cashless medical treatment based on deferred payment. Insurance companies, generally, have wide network of hospitals across the country. These network hospitals are also known as Cashless Network Hospitals.

How do Cashless Network Hospitals work?

Cashless network hospitals work similar to non-network hospitals or regular hospitals for the most part. You can visit a network hospital and get health care without having to pay to the hospital. This includes room rent (subject to a limit), admission charges, doctor or specialist fees, ambulance cost, and not to forget the treatment cost.

Your insurance provider would settle your medical bills against the Sum Assured, which you chose while purchasing your health insurance policy.

The insurer would bear all the aforementioned expenses, provided that the treatment was assured by your health plan.

You simply have to inform the hospital that your treatment cost would be covered under the cashless facility, and submit a valid identity proof, such as an identity card issued by the insurance provider or your policy documents.

Benefits/Advantages of Cashless Network Hospital:

When you get hospitalized for any treatment - be it emergency or routine check-up, it’s a stressful time for your family and you. Many hospitals insist on periodic clearance of the medical bills. In such a case, your family has to run around to pay exorbitant bills and make sure you receive quality healthcare at the same time.

With the cashless medical service, your insurance provider pays your bills after the completion of your treatment.

In case you are away from your residence and you need to get hospitalized, you can use any of your insurance provider’s network hospitals across the country to avail the treatment without making any payments or having to settle the incurred medical cost.

How do you file a claim through Cashless Network Hospitals?

In order to file a claim, you need to follow the procedure mentioned below:

  • In the event of a planned surgery, you need to inform your insurer to authorize the cashless treatment.
  • In case of an emergency treatment or surgery, you must inform your insurance provider within 24 hours of you being hospitalized.
  • In certain cases, you will be given an identity card. You can use this ID card to avail cashless services at any of your insurer’s partner hospitals.
  • You can undergo a treatment at any network hospital without making any payment.
  • The insurance provider would then send you a summary of all the charges applicable, and you have to pay for the exclusions (if any).

List of Treatments covered by Cashless Network Hospitals:

Cashless hospital claims cover the treatment that requires a hospital stay over 24 hours.

The list of the day-care facilities (requiring less than 24 hours stay) is as follows:

Operations on Eyes-this consist of the following treatments:

  • Eyelid incision
  • Cataract operation
  • Tear duct operation
  • Corneal incision
  • Corrective surgery for ectropion, entropion
  • Removal of foreign body

Operation on Ears:

  • Stapedectomy
  • Stapedotomy
  • Operation on the middle-ear
  • Operation on auditory ossicles
  • Reconstruction of the middle ear
  • Tympanoplasty
  • Other operations on the inner ear
  • Incision of the inner ear

Operation on the tongue:

  • Glossectomy
  • Reconstruction of tongue
  • Other operation on the tongue

Operation of sinus and nose:

  • Nasal sinus aspiration
  • Foreign body removal
  • Operation on the nasal concha
  • Other operation on the nose

Operation of bones:

  • Dislocation surgery
  • Meniscus tear and ligament tear surgeries
  • Sutures and fractures of tendons
  • Orthopaedics and trauma surgeries
  • Other bone and joint surgery

Operation of subcutaneous tissues and skin:

  • Skin restoration and transplantation
  • Incisions of subcutaneous tissues and skin
  • Excision of subcutaneous tissues and diseased skin
  • Chemosurgery to the skin

Operation on face:

  • Incisions to face, jaw and mouth
  • Plastic surgery to mouth
  • Other operations to the face and mouth

Operations:

  • Chemotherapy
  • Radiotherapy (for cancer)
  • Lithotripsy
  • Haemodialysis
  • Coronary angiography

Cashless claims also cover surgical treatments and procedures in the digestive tract along with female and male reproductive organs.

Exclusions under the Cashless Network Hospitals:

While cashless hospitalization covers a number of treatments and medical procedures, there is a list of exclusions as well, under which your insurance provider does not pay for the treatment. Some of the exclusions are listed below:

  • Treatments arising out of suicide, self-injury or self-harm when insane or sane
  • Hospitalization due to radiation, biological or chemical weapons, or war
  • Treatments due to the complications arising out of AIDS/HIV, unless mentioned in the document of the policy
  • Items of personal convenience or comfort
  • Hospitalization arising out of the abuse of alcohol or psychotropic substances
  • Additional cost such as special diets
  • Mental disorders and congenital diseases as mentioned in the document of your policy
 

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