Network and Non-Network Hospitals: What is the Difference?

Health insurance is a valuable cover that provides financial protection when medical emergencies lead to hospitalisation. However, understanding the terms of an insurance policy can sometimes be confusing, especially when it comes to "network" and "non-network" hospitals. These terms generally help distinguish between hospitals that have partnerships with your insurer and those that do not. Keep reading to clearly understand the difference between network and non-network hospital.

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      What is a Network and Non-Network Hospital?

      Health insurance companies are well aware that private medical set-ups tend to charge more from patientswith health insurance plans rather than those without it. This naturally translates to losses forinsurance providers. In order to ensure profitability and avoid incurring unnecessary losses, health insurance providers tie up with certain hospitals, making them a part of their 'network'.

      Taking into consideration which hospital maximum number of policyholders go to in specific areas, insurance companies negotiate treatment and stay costs with these select network hospitals to prevent their expenses from spiralling.

      Therefore, hospitals that are affiliated with health insurance companies are referred to as network hospitals. All other hospitals outside this mutual network are referred to as non-network hospitals.

      Moreover, as per the recent 'Cashless Everywhere' initiative, policyholders can avail of cashless medical treatment at any hospital of their choice, even if it is not part of the insurance company's network.

      What is the Difference Between a Network and Non-Network Hospital?

      The differences between network and non-network hospitals are highlighted in the table below:

      Features Network Hospital Non-Network Hospital
      Cashless Treatment Facility Network hospitals provide cashless treatment facility. Cashless treatment facility is not provided by non-network hospitals.
      How it Works? The insurer settles hospital bills directly and the policyholder pays only the deductible, if any. Policyholder pays the entire bill upfront and then files a reimbursement claim.
      Waiting Period There is no waiting period after the approval. The insurer settles the bill immediately. Generally, there is a 10-12 day waiting period (may vary by insurer) before getting the claim settled.
      Claim Settlement Process The claim settlement process is quick. The claim settlement process is usually slower and may require additional approval time.
      Additional Convenience No need for immediate cash arrangement and the focus is on treatment & recovery. Requires handling all payments and paperwork, which can be stressful, especially during emergencies.

      Understanding the Working of Network and Non-Network Hospitals

      The following examples will offer a better understanding of the major difference between getting admitted in a network hospital and a non-network hospital, and how it can impact health insurance claims:

      Example 1: 'A' holds ahealth insurance policy without the cashless benefit. Upon facing a health issue, he gets admitted into a network hospital where he gets medical treatment as per his needs. However, he will have to bear the bills at that moment. Following discharge from the hospital, 'A' will need to submit his medical claim to the health insurance company with all the required original documents. The insurer will check all documents, process the application, and give final approval on the submitted claim in accordance with the policy terms and conditions.

      Get More:Find Network Hospitals in Your Area

      Example 2: 'B' is covered with cashless insurance under his health insurance policy. He is diagnosed with an illness, and decides to get admitted into a network hospital. Since 'B' has the cashless benefit, his family members get in touch with the third party administrator (TPA) to help him avail the cashless hospitalisation benefit. 'B' therefore gets excellent medical treatment without having to spend a penny from his own pocket. Following discharge, 'B' takes all the required claim-related documents to keep as records. In this case, 'B' will only need to bear those expenses that the policy explicitly states as not being covered.

      Example 3: 'C' has a health insurance policy and on being diagnosed with an illness, he gets admitted in to a non-network hospital. In such a situation, it does not matter whether 'C' does or does not have a cashless medical cover. Either way, he will not get this benefit from the insurance company, since he chose a non-network hospital.

      'C' avails of the requisite medical treatment and bears the entire medical expenditure out-of-pocket. Following discharge, he files a reimbursement claim with his insurance provider with all the original supporting documents. The insurer takes a microscopic look into each cost and only approves the amounts found reasonable and justified enough to be approved under the terms of the policy. The insurance company may approve either the full claim or only a part of it.

      Who Wins - Network Vs Non-Network Hospital?

      From the above examples, it is clear that getting medical treatment in a network hospital is always better and wiser.

      Every health insurance policy clearly mentions the complete list of all the network hospitals they are associated with. It is a good idea to have the network hospitals list always handy for quick reference during emergencies. This turns out to be a blessing in the event of sudden hospitalisation, as the policyholder can immediately approach any of the network hospitals and avail of either the medical treatment at reasonable cost or cashless hospitalisation benefit.

      However, please note that in case of pre-planned hospitalisation, the policyholder must contact the TPA and get all the necessary approvals beforehand.

      On a Final Note

      Understanding the difference between network and non-network hospitals can help you make better decisions during medical emergencies. Choosing a network hospital over a non-network hospital offers greater convenience, with benefits like no waiting period, cashless treatment and quicker claim settlement. With this, even policyholders and their families can focus on recovery instead of worrying about arranging funds on an immediate basis.

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      Disclaimer: The list mentioned is according to the alphabetical order of the insurance companies. Policybazaar does not endorse, rate or recommend any particular insurer or insurance product offered by any insurer. For complete list of insurers in India refer to the Insurance Regulatory and Development Authority of India website www.irdai.gov.in

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