In cashless facility, how much deduction in claim amount is faced by hospitals?

In cashless facilities for health insurance in India, hospitals may face deductions in the claim amount approved by the insurance company. The amount of deduction can vary depending on several factors such as the terms and conditions of the insurance policy, the pricing and coding of medical procedures, and the coverage limits and exclusions of the policy.

In some cases, hospitals may face deductions of a few percentage points to a significant proportion of the claim amount. Deductions may occur if the medical treatment provided is not covered under the policy, if the policy has a cap on the amount that can be claimed for a specific medical procedure, or if the hospital charges more than the rates negotiated with the insurance company.

The extent of deduction in the claim amount can also depend on the negotiation power of the hospital with the insurance company, as well as the documentation and evidence provided by the hospital to support the claim.

It is worth noting that deductions in claim amounts are a common challenge faced by hospitals in the cashless facility of health insurance in India. Hospitals may need to have adequate financial resources and processes in place to manage these deductions and ensure the sustainability of their operations.

Overall, the extent of deductions in claim amounts can vary significantly and is influenced by several factors specific to each case. Hospitals may need to work closely with insurance companies to understand the terms and conditions of the policy and negotiate the best possible terms for their patients.