The hospital bill might leave you stunned! Know these secret rules before getting admitted to save 100% of the cost..

A health insurance policy acts as a significant financial safety net during an illness or medical emergency. However, it is often observed that even with a policy in place, many people end up paying for hospital expenses out of their own pockets. If you wish to avoid paying a single rupee from your own pocket during treatment, it is crucial to understand the concept of 'network hospitals' before getting admitted. In insurance terminology, the distinction between network and non-network hospitals determines whether your treatment will be entirely cashless or if you will have to go through the hassle of seeking reimbursement.

Simply put, network hospitals are medical facilities that have a direct business agreement (tie-up) with insurance companies. Under this agreement, the hospital and the insurance company pre-determine the rates for various treatments and surgical procedures. When a policyholder seeks treatment at these network hospitals, there is no need for out-of-pocket payment. The hospital directly coordinates with the Third-Party Administrator (TPA) or the insurance company to settle the entire treatment cost. This process is completely cashless and stress-free, ensuring the patient's family does not face a sudden financial burden.

**Full cost must be paid out-of-pocket at non-network hospitals**

Conversely, non-network hospitals are those that do not have an agreement with a specific insurance company. If you are admitted to a hospital that is not on your insurance company's list, you will not be eligible for cashless treatment. In such a scenario, the patient must pay the entire hospital bill out-of-pocket at the time of discharge. Once the treatment is complete, you are required to submit all original hospital bills, medical reports, and the discharge summary to the insurance company to apply for reimbursement—a process that can take considerable time to get approved.

Keep these points in mind before hospital admission.
It is prudent to take certain essential steps before commencing treatment at any hospital. First, visit your insurance company’s official website or mobile app to check the updated list of network hospitals in your city, as this list changes periodically. Additionally, visit the hospital’s ‘TPA Desk’ to confirm whether the cashless facility is active for your specific policy. In the case of a planned surgery (scheduled treatment), fill out and submit the pre-authorization form to the company at least 48 to 72 hours before admission to avoid last-minute approval delays.

Risk of deductions in reimbursement claims
A major downside of filing reimbursement claims for treatment at non-network hospitals is that insurance companies do not cover the entire bill. They approve claims based on their standard rates and policy terms; consequently, significant amounts are often deducted due to costs associated with consumables (medicines, gloves, etc.) and room rent capping. Therefore, to avoid unwanted financial loss and mental stress, always prioritize network hospitals. This simple precaution ensures you receive excellent treatment that is 100% free, sparing you from the burden of exorbitant hospital bills.

Disclaimer: This content has been sourced and edited from News18 Hindi. While we have made modifications for clarity and presentation, the original content belongs to its respective authors and website. We do not claim ownership of the content.