Here are a Few Differences Between Network and Non-Network Hospitals
Competition in the health insurance industry has become relatively high these days; to ensure that they sell as many policies as possible, companies want to offer increasingly valuable services to entice customers to choose them. One such facility is the network of hospitals. To avoid substantial claims from unknown hospitals, insurance companies research the reliable and popular hospitals in an area and zero in on the ones they want to work with. They can then negotiate the costs of treatment with the hospital and invite them to join their network.
What are a Network and a Non-network Hospital?
A network hospital appears on your insurer’s list of associated medical institutions, which means that these are all the hospitals where you can use cashless health insurance. You will not have to worry about hospital bills as your health insurance company will handle the amount and the process for you.
A non-network hospital does not appear in the list of your insurer’s partner hospitals. If you are hospitalised in a non-network hospital, you will have to pay the entire bill by yourself and out of your pocket. However, if you have a health insurance policy, you can file a health insurance claim and get reimbursed for the money you spent in a non-network hospital.
What is a Cashless Facility?
Most well-known health insurance providers offer a cashless service; this means that in the case of hospitalisation at a network hospital, you, as a policyholder, will not have to worry about the hefty medical bills that can pile up. After you submit appropriate documents, such as the health insurance card before hospitalisation, the insurance company will take over dealing with the finances directly with the network hospital. This occurs provided the policy covers the cause for hospitalisation.
Differences Between Network and Non-network Hospitals
| Network Hospital | Non-network Hospital |
| When you buy an insurance policy, the insurer will also provide you with a list of hospitals to which it is connected. All the hospitals on this list are network hospitals. | Any hospital that’s not on this list is a non-network hospital. |
| The cashless claim facility can only be activated at network hospitals. The insurer will pay the hospital directly | You cannot avail cashless claim service at a non-network hospital, and you will need to pay out of your pocket in case of hospitalisation. |
| When it comes to the administrative process of being hospitalised, it is much easier to get admitted into a network hospital. There is minimal paperwork involved other than submitting a valid ID proof and the health insurance card. | If you are admitted into a non-network hospital, the process will likely be longer. This is because you will have to collate and maintain all the paperwork to submit a claim with your insurer, who will take their time to comb through all the expenses and reimburse you. |
| There is no waiting period in the case of network hospitals, as the insurer will handle the payment process directly with the medical institution. | As far as hospitalisation at a non-network hospital goes, there is a waiting period spanning 10 to 30 days and sometimes even more for you to be reimbursed. This can be disconcerting if you are short on finances and may even upset your and your family’s financial goals. |
Conclusion
Reading all the differences between network and non-network hospitals, you would have realised how helpful and crucial cashless claims can be. To avoid the additional step of paying the hospital and filing a claim with your insurer, you need to check how extensive a network your insurance company has. Only go for non-network hospitals when there's an emergency or the treatment you seek is unavailable at any of the hospitals in the insurer's network. Additionally, you should always keep a list of network hospitals handy, and all your family members should also be aware of their location so that they can decide for you if you cannot make a decision about which hospital to go to.
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The benefit of going to a network hospital is that you will not have to stress about the payment and all other related processes during your or your family's hospitalisation. In the time of sickness, the worry of paying the hospital bill should be the last thing on your mind. Therefore, the cashless claims facility, which is applicable in insurance policies which cover a vast network of hospitals, is quite beneficial.
If you are admitted to a network hospital, all you need to do is submit your insurance card and valid ID proof at either the reception or your doctor. You also have to complete a pre-authorisation form, and most hospitals will have a TPA (Third Party Administration) counter where you can submit it. The hospital will then pass this form on to the insurance company. A relative can do it for you if you cannot engage in this process.
In non-network hospitals, you will have to pay the entire medical bill and file your claim with the insurer for reimbursement for your unforeseen expenditure. Look into your insurer's track record in response to claims settlement ratio and the usual time they take to reimburse the money. Also, remember to safely and neatly maintain all the documents related to your hospitalisation, as it will help make the filing process very smooth and manageable.
Several reputed companies have connections with a vast network of hospitals. As a part of your research, visit the insurer's website and look up their list of network hospitals. Remember to look at hospitals which are closer to you by location.
Many health insurance companies provide policies, and deciding which is the right plan for you can get confusing. The factor to be kept in mind while evaluating the options are as always:
- Network coverage – Find out whether there is a network hospital close to your house so that in case of an emergency, you won’t waste precious time looking for one or travelling far.
- Amount of premium
- Policy sum insured
- Customer relations
- Claims success ratio