What are the difficulties faced by hospital after getting cashless facility in health insurance ?

Even after getting cashless facility in health insurance, hospitals may still face some difficulties. Here are some examples:

  1. Delayed payments:

    Insurance companies may take a long time to process the claims and reimburse hospitals for the services provided. This can affect the hospital's cash flow and may lead to financial difficulties. For example, if an insurance company takes several months to reimburse a hospital for a cashless claim, the hospital may struggle to pay its vendors or employees on time.

  2. Rejected claims:

    Insurance companies may reject claims if they find any discrepancies or if the treatment provided is not covered under the policy. This can lead to disputes between hospitals and insurance companies and may result in delayed payments or loss of revenue for the hospital. For example, if a hospital provides treatment for a medical condition that is excluded from the policy coverage, the insurance company may reject the claim, leaving the hospital with no reimbursement.

  3. Increased administrative workload:

    Offering cashless facility involves a lot of administrative work, including pre-authorization, documentation, and follow-up with insurance companies. This can increase the workload of hospital staff and may result in delays in providing medical services to patients. For example, if hospital staff spend a lot of time on administrative work related to cashless facility, they may have less time to attend to patients, resulting in longer waiting times and lower patient satisfaction.

  4. Disputes with insurance companies:

    Even after getting cashless facility, hospitals may face disputes with insurance companies over the amount of reimbursement or the treatment provided. This can lead to lengthy legal battles and may result in financial losses for the hospital. For example, if an insurance company disputes the charges for a medical procedure provided by a hospital, the hospital may have to go to court to defend its charges, resulting in legal fees and loss of revenue.

  5. Increased paperwork and documentation:

    Hospitals may have to maintain a lot of paperwork and documentation to process cashless claims. This can lead to increased administrative work and may result in delays in processing the claims.

  6. Compliance with regulations:

    Hospitals need to comply with various regulations such as the cashless claims settlement process, data security, and patient privacy, among others. Any non-compliance can result in penalties or legal issues.

  7. Low reimbursement rates:

    Health insurance companies may negotiate lower reimbursement rates for medical procedures with hospitals, which can lead to lower revenue and financial strain on the hospital.

  8. Lack of transparency:

    There may be a lack of transparency in the cashless claim settlement process, which can lead to confusion and disputes between hospitals and health insurance companies.

  9. Complex billing process:

    Insurance companies may require hospitals to follow a complex billing process, which may involve submitting multiple documents and forms. This can be time-consuming and may require dedicated personnel to handle the paperwork. Any errors or omissions in the billing process may lead to delayed or rejected claims, resulting in additional administrative work for the hospital.

Overall, hospitals may face some difficulties after getting the cashless facility in health insurance. However, being a part of the network of hospitals associated with health insurance companies can increase their patient base and revenue, making it a beneficial option in the long run. Hospitals need to manage their operations effectively and maintain good relationships with health insurance companies to mitigate these difficulties