DESUN Hospital & Heart Institute is now a proud member of PPN or Preferred Provider Network.
Simply put, it is the organisation of medical doctors, hospitals and healthcare providers who come to an agreement with an insurer, or third- party healthcare providers to provide reduced healthcare to the insurer’s clients. These networks are also known as a PPO (Participating Provider Organization, or Preferred Provider Option).
It all started in 2010. Health insurance companies cried foul and alleged that hospitals were inflating bills to policy holders. The modus operandi of various hospitals was simple. They were charging policyholders at inflated rates for medical treatments, knowing that the insurance companies would refund the bills to them anyway.
This naturally led to insurance companies having to pay more for treatments which, in turn, started hurting their bottom line.
This forced health insurance companies to look at this issue of escalating costs and on July 1st, 2010, the Preferred Provider Network (PPN) was launched by them.
What the Preferred Provider Network (PPN) essentially did was fix the rates of surgeries and treatments for hospitals. The preferred provider network health insurance model meant that new rate cards would be applicable and that hospitals could not dictate the cost of generic treatment to policyholders. A panel of approved hospitals for cashless claims settlement was created and this came to be known as the Preferred Provider Network (PPN).
Unfortunately, many hospitals refused to fall in line like this and start using the proposed billing structure. As a result, they opted out of participating in the Network. This obviously caused a lot of grievance to policyholders who wanted to avail of the cashless facility as promised under health insurance but could not do so because the hospitals had not joined the PPN framework. As a result, the policyholders had to pay for the treatment themselves in hospitals that were outside the PPN network and claim the money later on from the health insurance companies.
In a recent development, under the initiative taken by Four(4) major health insurance firms viz. National Insurance, Oriental Insurance, United India Insurance and New India Assurance, a large number of hospitals have agreed to the new set of tariffs. All the hospitals that in the last one year had declined to join the Preferred Provider Network (PPN) are now in. The rates have now been fixed for around 40 procedures and these include open-heart surgery, cataract, knee replacement, gall bladder operation and even childbirth. It is welcome news for policyholders looking for cashless facility under health insurance.
Another side-benefit is that the insurers have forced hospitals to actually reimburse the extra charge that the patient was billed for. So in case of overbilling, the insurer is asking hospitals to refund the extra charges back to the patient while it settles the legitimate charges. What this means is that over a period of time, the hospitals will charge more meaningful rates from customers at the very first go. This will be beneficial both for the patient and for the health insurance company as it will improve their finances. It will also result in a more or less uniform pricing structure across all hospitals where there will be little room for any nasty surprises.