What are Network Hospitals for Health Insurance Companies?

Introduction

INFLUENCERS - they are all the rage now, right?

I mean cosmetics to financial product selling - anywhere you look across social media platforms, you see influencers. They have become major social media marketing instruments. The way it works is a TIE-UP, a PARTNERSHIP between an influencer and the company that they are endorsing. While the company gets its widespread network of marketing, the influencers get paid in cash and in-kind (freebies, etc.).

Similar symbiotic partnerships exist across all industries and the health insurance market is no exception. Their tie-ups extend to influencers, banks, and hospitals. While the former two are interesting topics, we will take them up on that in some other blogs of ours.

Today, we will be talking about network hospitals in health insurance - how they function, why are they important, and the kind of cashless perks they offer to the policyholders.

What are Network Hospitals in Health Insurance?

A network hospital in health insurance indicates a medical facility that has entered into a legal agreement with a health insurance provider to offer healthcare services to their company’s policyholder with cashless perks and subsequently, the invoice is settled directly by the health insurer.

This setup is a huge step up for both parties -

• FOR THE NETWORK HOSPITAL: They get a huge number of patients via the health insurer as compared to the stereotypical channels of no-reference.
• FOR THE HEALTH INSURANCE PROVIDER: When policyholders get admitted to the partner hospitals, the billed amount skyrockets. Now, since these are network hospitals, insurers are liable to pay the invoices off on their own (unless there is a copayment clause in the policyholder’s health insurance policy document). With a legal tie-up with the hospital in place, the bills get cut down substantially considering the spike in patient inflow that is extended by insurers.

This symbiotic relationship is a substantial perk for the policyholders too. Here’s a look at why network hospitals in health insurance are considered significant.

What is the significance of network hospitals for health insurance providers & policyholders?

To know the significance of network hospitals in health insurance policies, one must first acknowledge the difference between partner and non-partner hospitals. Let’s take use cases for  a more lucid understanding -

Now that you know why cashless modes of payments earned via network hospitals are preferred over the reimbursement payments that are a mandatory situation in non-partner hospitals, here’s a look at the significance of the former -

A. For the health insurance providers

• COST CONTROL: Whether it’s a network hospital or a non-network hospital, with or without copayment clauses, health insurance providers have to settle large amounts over claims. With the network hospitals, the bill has to be cleared sooner and with non-network ones, there is a window of a month (approximately).

However, in the case of network hospitals, since there is a promise of channelling of higher patient influx, there is a negotiation struck that leads to a cut down on the skyrocketed bills. This helps health insurers defend their financial standing by a considerable amount.

• BUILD CREDIBILITY: The more partner hospitals enlisted in a health insurer’s document, the better reputation he holds among potential policyholders. With a huge network of partner hospitals, insurers give away the impression that they are financially strong for the future too, enough to have strengthened their ties with so many medical facilities.

Additionally, several widespread networks of partner hospitals ensure convenience for policyholders and their quick access to partner hospitals for quality treatments with the cashless perk.

All of this acts as a catalyst for policyholders to avail of a health insurance policy from reputed providers.

B. For the health insurance policyholders

• CASHLESS MODE OF PAYMENT: Partner hospitals offer a unique perk to the policyholders - a cashless mode of payment. No matter the billed amount, unless there is a disease-wise sub-limit or a copayment clause involved, the health insurer has to pay off the claimed amount.

With a network hospital involved, this billed amount requires no investment from a policyholder’s savings. They are paid off at the earliest by the health insurer in question.

• CONVENIENT TREATMENT OPTIONS: With network hospitals in play, policyholders can have access to tailored healthcare providers, their teams, and treatment procedures with the imbibed cashless perk. This boosts access to quality healthcare services without any pressure on one’s savings pocket.
• SMOOTH CLAIM SETTLEMENT PROCESS: The entire transaction is conducted between the provider and the hospital in question, with a limited role being played by the insured. Thus, the time involved in the process is mitigated considerably, making the claim settlement process smooth and less time-consuming.

Network Hospitals and Health Insurance Providers

One of the thumb rules to ensure that you have come upon the best health insurance providers is that they have the maximum number of network hospitals that are closest to the location of the proposer and policyholders of the health insurance policy.

Insurers approach these healthcare facilities and negotiate

• The ailments and treatments that would be covered in their best health insurance plans,
• The disease-wise sub-limit (if applicable) allowed on medical procedures, and
• The hospital stay costs.

This helps health insurance providers shield their finances by controlling the spiralling cost of hospital bills for all policyholders.

Take a look at some of the best health insurance providers across the country and the number of network hospitals enlisted under them -

How to Settle Claims in Network Hospitals?

Considering how cashless claims are the best perk for partner hospitals, the entire claim settlement process is crucial for any policyholder to reap the maximum benefits of this feature.

STEP 1: INFORM INSURER/TPA

• If it’s a pre-planned hospitalisation, the policyholder needs to approach either the Third Party Administrator (TPA) or the health insurer and inform them about the procedure they are about to undergo at least 72 hours in advance.
• If it’s an emergency, the TPA/insurer needs to be intimated within 24 hours of the hospitalisation.

STEP 2: Provide your e-health card comprising the health insurance policy number at the hospital desk.

STEP 3: Fill up the health insurance form and submit the document with your TPA/health insurer.

STEP 4: The invoice once generated from the hospital desk is sent over to the insurer, who verifies the treatments conducted and pays off the claim amount.

Conclusion

When it comes to health insurance plans, one of the common nations why these are availed of is to mitigate the pressure that medical emergencies and treatments put on the savings of a policyholder. However, if one approaches a non-network hospital, initially it is the policyholder who has to clear the sum. Although this amount is later reimbursed by the insurer, the initial financial shorting is alarming.

On the other hand, with a network hospital for health insurance, any such financial gaps are conveniently skipped, thereby, fulfilling the requirement of availing of health insurance in the first place.