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

Hospitals may face several difficulties while getting the cashless facility in health insurance. Some of these difficulties are:    

  1. Tie-ups with insurance companies:

    Hospitals need to have tie-ups with insurance companies to offer cashless facility. However, getting these tie-ups can be a time-consuming process, and some insurance companies may have strict criteria for selecting hospitals for their network. For example, some insurance companies may require hospitals to have a certain number of beds or a specific set of medical facilities.

  2. Empanelment process:

    To become a part of the network of hospitals associated with health insurance companies, hospitals need to go through a rigorous empanelment process. This process includes fulfilling several criteria such as infrastructure, facilities, quality of services, and patient feedback, which can be challenging and time-consuming.

  3. Compliance with insurance company guidelines:

    Hospitals need to comply with the guidelines and procedures set by insurance companies to offer cashless services. These guidelines may vary from one insurance company to another, and hospitals need to ensure that they meet all the requirements. For example, some insurance companies may require hospitals to maintain certain standards of cleanliness, hygiene, and medical equipment.

  4. Negotiations with insurance companies:

    Hospitals may have to negotiate with health insurance companies on various aspects such as the rates for different medical procedures, the terms and conditions of the cashless facility, and the reimbursement process.

  5. Documentation:

    To offer cashless services, hospitals need to submit a lot of documentation to insurance companies, including details of the treatment provided, bills, and other medical records. This can be a time-consuming process and may require dedicated personnel to handle the paperwork. For example, hospitals need to submit pre-authorization forms, claim forms, and other documentation to insurance companies to get cashless facility.

  6. Disputes with insurance companies:

    Sometimes, insurance companies may dispute the hospital's bills or treatment charges, leading to delays or denial of cashless facility. Hospitals need to have a robust system in place to handle such disputes and ensure that they receive the reimbursement they are entitled to. For example, insurance companies may dispute the charges for certain medical procedures or medicines, and hospitals need to provide adequate justification for the charges.

  7. Claim rejection:

    There is a possibility that the insurance company may reject a cashless claim made by the hospital for various reasons such as non-coverage of the medical procedure or lack of sufficient information. In such cases, the hospital may have to bear the expenses of the medical treatment, leading to financial losses.

  8. Limited coverage:

    Some insurance policies may have limited coverage or exclusions, which may not be beneficial for the hospital or the patient. Hospitals need to be aware of the policy coverage and exclusions to avoid any misunderstandings or disputes with insurance companies. For example, some insurance policies may not cover certain medical conditions or procedures, which may result in the hospital not being able to provide cashless facility for those treatments.

  9. Delay in payment: Even after a successful cashless claim, there may be delays in payment by the insurance company, leading to financial strain on the hospital.

  10. Technical issues: Hospitals may face technical issues while processing cashless claims, such as incorrect data entry or software glitches, leading to delays or rejections of claims.

    Overall, hospitals may face various challenges while 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.