Upon availing services/ procedures in an Insurer’s Network Hospital, the policyholder will not be required to pay for the treatment, and the Insurer through the TPA will directly pay the hospital.
Usually, the hospital sends an estimate of treatment charges once the patient is diagnosed. The TPA/Insurer approves the estimate. This is called a pre-authorization request and approval. Once, the treatment is completed, the hospital bills the Insurance Company and gets paid. Whatever treatment charges over and above the approved amount has to be paid by the policy holder to the hospital directly.