In order to prevent any form of deductions, inquiries, or delays in the claim procedure, it is necessary to receive treatment at network hospitals cashless.
To make the notion easier to understand, let me give you an example:
Let’s say Mr.Sharma had a kidney stone removed at a network hospital . Instead of using his insurance’s cashless option, he elected to pay the hospital directly and then file a reimbursement claim with his insurer.
However, after analyzing his claim, the insurance company discovered a large deduction.
The reason for this reduction is the pre-negotiated fees between the insurance company and the hospital. The insurance company had worked out a discounted package of Rs. 75,000 for the specific surgery with the hospital. Despite this arrangement, the hospital billed Mr. Sharma Rs. 1,10,000 under the open pricing.
Mr.Sharma did not choose the cashless facility, thus the insurance company processed his reimbursement claim at the agreed-upon discounted rate of Rs. 75,000.
As a result, the deduction is equal to the difference between the hospital’s open tariff amount and the insurance company’s discounted package rate.
Additionally, the insured is responsible for submitting claims and fulfilling any queries or document requirements, which can sometimes be a cumbersome process. Therefore, it is advisable to always opt for cashless treatments in authorized hospitals.