Your Guide to How Cashless Network Hospitals Work

Mohan is an average middle -class guy who works with a 9-6 job. He has a young wife approaching her due date. He lives with his ageing parents as-well-as his mother in law – all three are older adults with their share of medical issues. Mohan's father has osteoarthritis and cataracts, his mother in law suffers from hypertension and heart disease finally we have his mother who has dementia. Being the only source of income in this family; it had made difficult for Mohan to take care of his older parents and expected wife.

One day Mohan’s mother runs out of the house causing Mohan’s pregnant wife to run around crowded streets looking for her. The stress of a lost adult causes her water to break – she calls an ambulance and is rushed to the pre-decided maternity hospital to have the baby. Mohan rushes to her from work with only the money in his pocket. This is where network hospitals play a significant role in making sure he can enjoy the birth of his baby and not have to worry about paying cash at that very moment.

In essence, it is a partnership between your health insurance company and a hospital. The bills are paid directly by the insurance company. However, the payments are settled by the insurance company after they receive approval from the Third Party Administrator (TPA). TPA’s also ensure that the hospital belongs to the network of hospitals where the insurance policy holds good.

TPA or Third Party Administrator (TPA) is an agency, corporation, or institute holding a license from Insurance Regulatory Development Authority (IRDA) to process claims - corporate and retail policies in addition to providing cashless facilities as an outsourcing entity of an insurance company.

Most policies seem similar on the first glance; if you carefully read the fine print, you may notice besides the basic features that there may be other benefits too. Typically, all health insurance policies will pay your hospitalisation charges after approval from the third-party administrator (TPA). But, you could always look out for the extra benefits like daily cash benefits or domiciliary treatment.

Do not be impressed by the list of Network Hospitals offered by your insurance company – distance from your home is a vital factor to consider. If Mohan’s mother in law is having a heart attack than an ambulance is no use if it’s going to take an hour to reach the Network hospital.

Go with the insurance provider who has the most extended list of cashless network hospitals. This gives you the advantage of moving as-and-when required. Suppose Mohan’s father needs cataract surgery and the hospital closest to the house is out of rooms – he can always choose another hospital from the list

So, you've finally settled on an insurance company you prefer, do not stop the quest just yet! It's always wise to inquire about the previous year's claim settlement ratio – it is the total number of death claims approved and passed by an insurance company, and is typically measured by the period of one financial year.

Choosing the right insurance plan can only happen when you thoroughly understand your own healthcare needs. List out your priorities and then make your final decision - the best cashless health insurance plan may have limitations, and it may not cover every contingency.