What is a hospital discount in mediclaim?

When it comes to healthcare expenses, medical insurance is a saving grace for many people. However, even with insurance, the costs can add up quickly, leaving many policyholders struggling to pay their medical bills. That is where hospital discounts come into play.

A hospital discount is a reduction in a hospital’s total bill amount for medical treatment, surgery, diagnostic, or any other healthcare service provided to you. Typically, insurers offer these discounts to help you reduce your out-of-pocket expenses. Insurance companies provide hospital discounts in collaboration with their network hospitals.

The Insurance Regulatory and Development Authority of India (IRDAI) issued an order in 2015 requiring all insurance providers to make it mandatory for hospitals to disclose any and all discounts on the final hospitalisation bill. This move aimed to increase transparency and ensure that policyholders are aware of any discounts offered by the hospital on their medical treatment bills.

Now that you are aware of hospital discounts, it is time to look at some methods for obtaining them.

Why do hospitals offer discounts?

Hospitals offer discounts for several reasons, many of which are tied to maintaining positive relationships with insurance providers and ensuring timely payments. Here are a few common reasons:

• Negotiated rates with insurance companies:

Hospitals often have agreements with health insurers to provide services at discounted rates. In return, they receive quicker payments and a steady stream of insured patients through referrals.

• Encouraging early or cash payments:

For patients who are not using insurance, some hospitals offer discounts for early or full payments. This helps make healthcare more affordable and simplifies the billing process.

• Minimising outstanding balances:

Offering reasonable discounts can encourage timely payments. This helps the hospital maintain steady cash flow and continue providing high-quality care.

• Strengthening patient relationships:

Discounts can make healthcare more accessible and show that the hospital is committed to patient well-being. This helps increase trust and long-term relationships with the community.

• Supporting preventive care:

In some cases, hospitals offer discounts on check-ups or health screenings. This promotes early diagnosis and helps patients stay healthy, reducing the need for more complex care later.

• Partnering with employers or organisations:

Hospitals may work with companies or community groups to provide health packages or discounted services. This improves access to care while expanding the hospital’s reach.

• Offering package deals for common procedures:

Fixed-price treatment packages for surgeries or other procedures make costs clearer for patients and help them plan better, while ensuring affordability.

How hospital discounts work in mediclaim policy

Hospital discounts play a crucial role in Mediclaim, which is a type of health insurance policy that reimburses medical expenses or provides cashless treatment. Here’s how it works:

• Cashless claims:

If you're admitted to a network hospital, you may receive treatment without paying upfront. The hospital bills the insurance provider directly at a pre-negotiated, discounted rate.

• Reimbursement claims:

If you visit a non-network hospital, you can still claim reimbursement. The final bill may reflect standard hospital charges, but any discounts you receive will reduce the amount you're eligible to claim.

• Impact on family health insurance:

If you have a health insurance policy for your family, these discounts can help conserve the overall sum insured.

• Helps stay within sub-limits

Some policies have sub-limits (for room rent, surgery or doctor’s fees). Hospital discounts make it easier to stay within these limits and avoid extra out-of-pocket costs.

• Supports faster claim settlement

Discounted and itemised bills are easier for insurers to process, leading to quicker claim approvals and reimbursements.

How to avail of a hospital discount while billing?

To make sure you don’t miss out on hospital discounts, follow these simple steps:

• Spot billing errors: Be vigilant about billing errors to save money on your medical bills. If you notice any discrepancies, connect with the hospital billing department immediately. Requesting an itemised bill can also help provide a detailed breakdown of charges for various services, pharmacy bills, inpatient stays, and other factors.
• Go for a health card: A health card with a No-Cost EMI option can help you pay your medical bills in convenient monthly instalments, reducing your financial stress. This benefit is available at all network hospitals affiliated with your insurer. Furthermore, various insurers provide hospital bill discounts when you swipe their health card.
• Negotiate: You can negotiate with the healthcare provider for a discount on your medical bill. Explain your financial situation and ask if they offer any discounts, payment plans, or other options to help reduce the cost.
• Upfront payment: Depending on the hospital, medical bills can also provide benefits similar to other cash payment discounts. This can be particularly helpful if you are dealing with expensive medical bills. Certain hospitals may offer a substantial discount if you settle the entire treatment cost upfront but remember that this offer requires immediate payment.

Tips to maximise hospital discounts

Hospital bills can add up quickly, but the good news is that there are ways to reduce costs without compromising on care. By having the knowledge and making smart decisions, you can take full advantage of the discounts available. Here are some handy tips:

• Choose network hospitals: These facilities often have pre-negotiated discounted rates with your insurer.
• Keep medical records organised: It helps in quicker processing and reduces disputes during claim settlements.
• Understand your family policy coverage: If you hold a health insurance policy for your family, know who is covered, the sum insured and any sub-limits, if applicable.
• Check for cashless treatment options: Many network hospitals offer cashless services, where the insurer pays the hospital directly. This saves you from having to pay out of pocket first.
• Ask about hospital packages: Some hospitals offer fixed-price packages for certain treatments or surgeries. These can be cheaper than paying for each item or service separately.
• Use preventive health check-ups: If your insurance offers free check-ups, take advantage of them. Early detection can help you avoid big hospital bills later on.
• Be aware of waiting periods: Some treatments, like dental or maternity, may have a waiting period. Knowing this can help plan better and avoid surprises.
• Negotiate when paying yourself: If you're paying without insurance or for anything not covered, you should ask for a discount or payment plan. Many hospitals are open to discussion.
• Know what’s not covered: Understand what your policy excludes, for example, cosmetic procedures or alternative therapies, so you’re not caught off guard.
• Use your insurance helpline: If you’re unsure about something, call your insurance provider’s helpline. They can guide you on how to get the most value and avoid unnecessary costs.

Conclusion

Hospital discounts in mediclaim policies are a valuable tool for reducing medical expenses and preserving your insurance benefits. Especially when you have individual health insurance, every rupee saved through discounts helps in making the plan more sustainable and beneficial.

When you understand how hospital discounts work and take proactive steps during hospitalisation, you can ensure a smoother, more affordable healthcare experience. Whether it's a routine check-up or an emergency, being informed puts you in control financially and otherwise.

Disclaimer: The information provided in this blog is for educational and informational purposes only. It is not intended as a substitute for professional advice, diagnosis, or treatment. Please consult your general physician or another certified medical professional for any questions regarding a medical condition. Relying on any information provided in this blog is solely at your own risk, and ICICI Lombard is not responsible for any effects or consequences resulting from the use of the information shared.