Dear HR Team, do you know about Blacklisted Hospitals? – A Must-Know piece of information for your Employees

Prologue: Nowadays, we are getting claims repudiated by insurers citing admissions taken in blacklisted hospitals. Most of the time, this rejection happens in reimbursement claims as the employee gets admitted unaware of this condition. It is important to educate employees about these blacklisted hospitals and advise them to check and opt for admission beforehand.

Reason for blacklisting: Hospitals can be blacklisted by insurance companies for a number of reasons, including:

– Fraudulent activities: Hospitals may collude with patients to create fake documents and bills
– Non-cooperation: Hospitals may not provide the required documents, making it difficult for insurers to process claims
– Excessive charges, inflating medical bills, and charging extra from patients: Hospitals may charge extra and high amounts from patients, which are then claimed from insurance companies
– Not meeting standards: Hospitals may not meet the required standards

Insurance companies also share data with each other, which can contribute to hospitals being blacklisted. Rarely, in some cases, insurance companies may allow charges for blacklisted hospitals if the admission is due to an emergency and the same is justified.

Plan of Action:

– Take the latest blacklisted hospitals’ details from the insurance company and circulate them among your team
– Repeat this activity at least quarterly
– Always ask the employee to check with your intermediary whether a claim from the respective hospital can be accepted by the insurer

Conclusion:

It takes just a few minutes to create awareness about this challenge among employees, rather than fighting or requesting the insurance company to consider a claim from a blacklisted hospital.