How Health Insurance Companies are controlling hospital by providing cashless facility?

Health insurance companies use cashless facility as a means of controlling the hospitals in their network. By empanelling hospitals and offering cashless facility to their customers, insurance companies are able to negotiate rates with hospitals and ensure that medical expenses are kept under control. Here are some ways health insurance companies control hospitals through cashless facility:

1. Empanelment of Hospitals:

   Health insurance companies empanel hospitals based on their quality of services, reputation, and cost-effectiveness. The hospitals must agree to the terms and conditions set by the insurance company in terms of the rates charged for medical treatment.

2. Negotiation of Rates:

   Insurance companies negotiate rates with the hospitals to ensure that the cost of medical treatment is kept under control. This helps the insurance company to limit their liability for medical expenses and control the premiums charged to their customers.

3. Pre-authorization of Treatment:

   Before a patient is admitted to the hospital, the insurance company provides pre-authorization for the medical treatment required. This helps the insurance company to control the costs of medical treatment and ensure that only necessary treatments are provided.

4. Claims Audit:

   Health insurance companies conduct regular audits of the claims submitted by hospitals to ensure that the medical treatment provided is necessary and that the rates charged are in line with the negotiated rates.

In this way, health insurance companies use cashless facility as a means of controlling the hospitals in their network and managing medical expenses. This helps the insurance companies to provide cost-effective health insurance products to their customers while ensuring that quality medical treatment is provided.