How to Verify a Hospital Before Raising a Cashless Claim?

Quick Reads:

• Check your insurer's website/app to confirm the hospital is on their network before admission
• Not all plans cover all hospitals; verify your specific plan works there
• Contact both the hospital and insurer at least 48 hours before planned surgery to confirm pre-authorisation requirements.
• Don't rely on old printed lists. You should always check the latest online information and confirm empanelment status directly
• If your preferred hospital isn't covered, switch to a network hospital, check for non-network cashless initiatives, or pay and claim reimbursement (5-7 days)

In times of medical emergencies and scheduled surgeries, the last thing you wish to worry about is whether the hospital is covered under your health insurance or not. This small detail can put a heavy financial burden on you. Before choosing a hospital, it is necessary to confirm whether the hospital is authorised to raise a cashless claim on your behalf. It takes only a few minutes to do so and can save you a lot of trouble during the most vulnerable state of your life.

Why Hospital Verification is Important for a Cashless Claim?

A cashless claim simply means that your insurer will directly pay the treatment expenses to the hospital. This facility is one of the main reasons why people buy health insurance. However, it will only benefit you if your preferred hospital is actually covered under your insurance plan. Most people are shocked to know that their preferred hospital is not covered under their insurance plan, or even if it is, it does not accept their insurance company. In such a scenario, you have two options: pay the hospital bill first and get reimbursed later or shift to another hospital. Either way, you will have to go through a lot of trouble, which can be avoided if you just verify the hospital beforehand.

Hospital verification ensures that you are not put in any disadvantageous position. It ensures that not only is the hospital empanelled with your insurer but also that they will be able to raise a cashless claim on your behalf.

How to Check the Insurance Hospital List?

Your insurer provides a list of empanelled or authorised hospitals on their website or mobile application. Here is how to use it:

Step 1: Log on to Your Insurance Company’s Website

Most leading insurance companies in India have a network of empanelled hospitals that can be viewed online. The website will have an option to search for network hospitals. You can also download the list of insurance hospitals for future reference.

Step 2: Search by City or Hospital Name

Search by city or the name of the hospital that you want to verify. You can also narrow down the search by selecting a speciality. The list of insurance hospitals will show you all the hospitals in your city along with their address and contact details.

Step 3: Confirm if Your Plan is Eligible for Cashless Claim

Even if a hospital is on your insurance company’s list of network hospitals, it does not mean that it will accept your plan for cashless hospitalisation. It is possible that the hospital only accepts your insurer’s premium health plans but not your entry-level plan. Confirm if your plan is eligible for cashless treatment at the hospital of your choice.

Step 4: Call the Hospital and Confirm

Even if you find all the information online, it is always a good idea to call the insurer to confirm. Ask the following 3 questions:

1.  Is the hospital empanelled with your insurance company?
2.  Does the hospital accept your plan?
3.  What is their pre-authorisation process and how long does it take?

Things to Verify Before Raising a Cashless Claim

Many claims get rejected for reasons like incomplete paperwork, which can be easily overlooked. So before you schedule your admission or surgery, keep the following in mind:

• Confirm if the hospital is on your insurer’s list of network hospitals
• Confirm if the hospital accepts your plan
• Call the insurer at least 48 hours before planned hospitalisation. The documents submitted during these claims are your policy document, medical reports and the estimated cost 
• In the case of an emergency, inform the insurer within 24 hours. Ask the hospital for the required documents that you will have to submit for pre-authorisation

Which are the Common Mistakes to Avoid While Raising a Cashless Claim?

There are certain common mistakes people make when checking the hospital list for insurance. Here are some of them:

Using Old Insurance Hospital List

Many people refer to the old printed insurance hospital list that came with their policy document. It is important to remember that hospital networks change with time. Always refer to the latest online insurance hospital list provided by your insurer.

Not Confirming Plan Eligibility

The hospital may be on your insurance company’s list. Still, it is always a good idea to confirm by calling the hospital or insurer if your plan is eligible for cashless treatment.

Not Confirming Empanelment Status

An empanelled hospital is a hospital that is in formal agreement with your insurer to accept cashless and reimbursement claims. Always call your insurer or the hospital to confirm whether your preferred hospital is part of your insurer's network in times of emergency; it can be a hassle to process a cashless claim if you choose a hospital outside the insurer's network.  

Being Unaware of Pre-authorisation Process

Every hospital has a slightly different pre-authorisation process. It is important to understand their process beforehand, as it can result in incomplete paperwork, which is a common reason insurers deny the claim.

What to do If your Hospital is Not on the Insurance Hospital List?

If your preferred hospital is not on the insurance hospital list, you have these options:

• The simplest and fastest thing to do is to choose another hospital from the insurance hospital list
• Confirm if your insurer is a part of the recently introduced industry-wide initiative that allows cashless treatment in non-network hospitals 
• Get treated at your preferred hospital, pay the bill yourself, and get reimbursed by your insurer later. Reimbursement can take anywhere between 5-7 working days depending on your insurer
• Some insurers also reimburse a certain percentage of the amount paid for treatment at non-network hospitals. Always check your policy document to understand your benefits better

Conclusion

Verifying your preferred hospital before raising a cashless claim is one such step that every policyholder must take. It is important to remember that a little bit of effort can save you a lot of trouble in the long run. Checking the insurance hospital list, confirming your plan eligibility and cross-checking with the hospital can save you from a lot of trouble when you are most vulnerable.

With India’s growing healthcare sector, insurers like Niva Bupa partner with hundreds of hospitals, ensuring your health insurance plan is your assurance of financial security in times of medical emergency. Make sure to use it to the fullest by choosing the right hospitals for cashless treatment. When a medical emergency strikes, you will be glad that you took the extra effort to verify your hospital and plan.

Frequently Asked Questions

How do I know if my hospital is empanelled with the insurer? 

Hospitals update their empanelment status with insurance companies regularly. There is a possibility that the hospital you have selected is no longer empanelled with your insurer. By calling the hospital, you can confirm that they are currently authorised to raise a cashless claim on your behalf.

What information is included in the insurance hospital list?

The insurance hospital list will include the hospital name, address, contact details, speciality and the plan accepted by the hospital. It is a good idea to confirm whether the hospital specialises in emergency admissions, day care treatment, or only planned surgeries.

What is the easiest and fastest way to verify a hospital?

The insurer's application is the easiest and fastest way to verify a hospital, as it shows the latest insurance hospital list and lets you save your preferred hospitals in the app. Some apps also allow you to raise a pre-authorisation request online.

What happens if my preferred hospital isn't on the network list? 

You can either pick another hospital from the list, check if your insurer supports industry-wide cashless tie-ups for non-network hospitals, or pay upfront and file for reimbursement, which typically takes 5-7 working days.

Why did my claim get rejected even at a listed hospital?

Your specific plan may not be eligible; some hospitals only accept premium plans, not entry-level ones. Incomplete pre-authorisation paperwork is also a common reason insurers deny claims.

When should I inform my insurer before hospitalisation? 

For planned admissions, notify your insurer at least 48 hours in advance; for emergencies, inform them within 24 hours of admission.

Insurance Hospital List

Can a hospital be removed from the network mid-policy-year without notice to policyholders?

Yes, hospitals and insurers can end their empanelment agreement at any point, and this doesn't automatically get communicated to individual policyholders. That's why relying on a hospital list you checked months ago is risky. It's worth re-verifying network status close to the actual date of admission rather than assuming it hasn't changed since you last checked.