Choosing the right insurance policy for your elderly parents can significantly enhance their quality of life in their golden years. As their age starts taking a toll on their physical well-being, a health insurance policy that is tailored to address their wants and needs is an absolute must. One of the biggest factors that should influence your decision when it comes to picking a good health insurance policy is the hospital network available with the insurer. Here’s how you can determine if a policy is right for your parents by evaluating the hospital network.
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How to Choose the Right Hospital Network for Senior Parents
The insurer and network hospital enter into an agreement that allows policyholders to opt for cashless claims at the hospital. Here, the insurer will directly settle medical bills with the hospital for approved treatments. The insurance company will cover the majority of the cost. The policyholder will only have to pay a minimal amount out of pocket.
This makes the claims process faster and less financially burdensome. With a non-network hospital, you will have to take the reimbursement route. Here, you will have to pay the cost of treatment upfront. Then you will have to save the related documents and submit them to the insurance company for approval. Post approval, the cost will be reimbursed. So, having a strong hospital network makes a big difference to the claims process and your finances.
Now we know why a good hospital network is crucial for your elderly parents. Here’s how you should go about choosing the right one.
This step gives you the critical data you need to narrow down which set of specialities your parents might need at a hospital. Knowing their pre-existing/chronic conditions and what they may be susceptible to in the future can help you come up with a plan that involves a health insurance company that has the right kind of hospitals and specialists under their network. This will facilitate a smooth treatment experience for everyone involved. Also, take into consideration the frequency at which your parents may need hospital visits for their treatments and follow-up consultations.
This is another fairly important step. The network hospitals should meet certain standards set by the Government of India for the safety of the patient. This will include accreditation from the National Accreditation Board for Hospitals & Healthcare Providers (NABH) and the Joint Commission International (JCI). These two organisations give accreditation based on factors such as hospital quality management and patient safety.
You will also have to look out for a hospital registration certificate, Clinical Establishment Act Registration, etc, to ensure that your parents are getting care from a legitimate establishment. Another factor to note would be the patient-to-staff ratio. This is crucial in the case of geriatric patients who may need more care and attention than a younger patient.
Elderly patients have a special set of needs. The hospitals that fall under an insurer’s network should specialise in geriatric care so that your parents get age-appropriate healthcare. Look out for a dedicated team of specialists who focus on geriatric care, cardiac care, and neurological care. Senior citizen care-focused physiotherapy centres and rehabilitation programmes present within the hospital are a great plus.
As your parents age, they may face situations where emergency care becomes a must. Check if the hospitals under the insurer have a reputable emergency care unit. This should include 24/7 ambulance service, emergency rooms, and a help desk to coordinate with the insurer. ICU, cardiac care, and stroke care units are also a must, as the elderly are more susceptible to heart attacks and strokes.
A hospital may provide the best care in the world. But if it is inaccessible during an emergency, the time lost while transporting the patient can become a matter of life and death. Depending on the frequency of hospital visits, a long journey to the hospital can become tiring for the elderly. Ensure that there are good hospitals within 5 to 10 km of your parents’ residence.
If nothing close is available to your house, then hospitals that are located in areas that are easily accessible through public and private transport should be given consideration. Also, note if the hospital has serviceable wheelchair access, elevators in working condition, and plenty of ramps so that your parents can get around easily.
Seeing is believing. Once you have done enough research, physically visit the hospitals that have passed your scrutiny on paper to get a sense of the place. A visit can show you what the hospital is good at and where it's lacking, so you can make your decisions based on what you have seen. Note factors such as cleanliness, wheelchair access, and wait time for consultations.
If you can, talk to people in your network who have received treatment from the hospitals in the network. This will give you a fair idea of what you can expect from the hospital. You can also check hospital ratings and patient/caregiver experiences on platforms such as Google and Practo. Take your family doctor’s guidance as well.
Some insurers can complicate the cashless claims process. Check if the process is TPA (Third Party Administrator) free. Also, ask if pre-authorisation and paperwork are required for admission. See if the hospital accepts the insurance plan you have in mind and covers the issues faced by your parents. The hospital should not exclude certain treatments and levy hidden charges at the time of discharge.
When your parents are admitted to a hospital network, the admission and discharge processes are carried out faster. This ensures peace of mind during trying times.
If you are in the market for health insurance for your senior parents, check the insurer’s hospital network without fail. Go through the list and see if the network is extensive and offers a wide range of hospitals in tier 1 and tier 2 cities. The network should also have hospitals at every budget point and cover most specialities. If the hospitals on the list comply with your needs as a caretaker of elderly parents, only then take up the insurance policy. This is to ensure that you don’t face any out-of-pocket expenses and experience a far smoother claims process when compared to opting for treatment at a non-network hospital.
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Reviewed by Dr. Harshita Dahiya 
Acko Technology & Services Private Limited
#36/5, Hustlehub One East, Somasandrapalya, 27th Main Rd, Sector 2, HSR Layout, Bengaluru, Karnataka 560102
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