Health Insurance November 13, 2020

Differences Between Network and Non-network Hospitals

When choosing a health insurance policy, an important citation you should look for is the cashless claim. In this facility, the claims will be settled in a cashless transaction if you are admitted to a network hospital. With a cashless claim, you can get the best possible healthcare without any worry of arranging cash. Apart from cashless, you can get your policy claim through a reimbursement too. It will work in both network and non-network hospitals. In this post, you will know the difference between network and non-network hospitals. Let’s read further to know the same.

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How to Identify Network and Non-network Hospitals?

Hospitals mentioned in your health insurance policy agreement are called the network hospitals. At these network hospitals, you can avail of the cashless health insurance service for treatment as per the company terms and conditions of your health insurance policy. However, hospitals not mentioned under your health insurance policy agreement are the non-network hospitals.

Formalities of Network and Non-network Hospitals

If your treatment is at a network hospital, you need to show your health insurance card. On the other hand, if you get hospitalized in a non-network hospital, you need to pay all the expenses and file a reimbursement claim to the health insurance company. In the case of a non-network hospitalization, most insured persons either get help from their relatives or spend all their savings.

Cash Arrangement for Non-Network Hospitalization

The drawback of going to a non-network hospital for treatment is that you have to arrange all the cash first. And before your discharge, you need to pay all the amount that is pending. However, in a network hospital, all of these processes would be cashless and the insured doesn’t have to worry about payment.

How Quickly Can You Get Cashless & Reimbursement Claims?

For a cashless claim, there is no waiting period. When you submit your health insurance card, the hospital will verify it with your insurer, and after the confirmation, the insurer will pay all the medical bills. In a reimbursement method, you need to carry the medical bills and submit them to the insurance company after discharge. For a reimbursement claim, the insurance company takes some time after you submit all the necessary documents to clear the insured amount.

Network Hospitalization v/s Non-Network Hospitalization

Insured people mostly prefer cashless treatment given that some may not have the savings to get their treatment done in the first place. That’s why you need to check the list of network hospitals. Because you can file the cashless claim only at the network hospital of the insurer. So check your health insurance plans and know if the cashless facility is available in the policy and the network hospitals where you can get the said service. ​

Every insurance company in India appoints a network of hospitals, clinics, and medical professionals who treat the policyholders at an affordable rate. In return, hospitals get more patients via the insurance company’s network. Insurers understand that in the case of an illness, the insured person will return to them with huge claims. It means the company will need to make substantial payouts. To turn the situation in its favor, the company negotiates with the hospitals and makes them a part of their network provider who treats the insured person. It turns out to be a profitable deal for both the hospital and the insurance company.

And the network hospital not only helps your insurer but even the insured individuals, who will get instant claims, enjoy documentation free claim process, and receive instant treatment for their illness or injury.

In a network hospital, you need to show your health insurance to seek treatment as an in-patient. Then, the patient needs to submit the duly filled claim form to the Third-party Administrator (TPA). Once the cashless claim is approved, you can get treatment and all the expenses will be borne by the insurance company without any hassle of further documentation.

In a non-network hospitalization claim, the documentation process is quite long as one has to submit the medical bills and documents to the insurance company within a stipulated time after the discharge. Check the time that your insurer has set for submitting the documents in a reimbursement claim. The insurer checks all the documents and approves if it finds the claim reasonable. The insured can get the claim amount after 10-12 days of successful verification

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