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What is the Meaning of Network and Non-Network Hospitals?

Author: Team Finpage
Network hospitals and Non-network hospitals in Medical Insurance
Thursday, May 16, 2024

The very thought of needing hospitalisation tends to cause anxiety even among those who are usually calm in the face of adversities. Added to this is the worry of skyrocketing medical costs. A recent study showed that India has among the highest medical inflation rates in Asia, of around 14%. Fortunately, there is health insurance to cover these costs. 

But what exactly happens when you need medical attention? Do you need to rush to the ATM first before going to the hospital? What is the process for clearing the hospital bills? The answer depends on whether the medical facility is a network or non-network hospital. 

What are Network Hospitals in Health Insurance?

Insurance companies often have affiliations with certain medical facilities. These work closely with the insurer to make it easier and more cost-effective for policyholders. These are called network hospitals.

What are Non-Network Hospitals in Health Insurance?

Any hospital or healthcare centre that does not have an affiliation with your insurance company is a non-network hospital. Since these hospitals do not have any direct relationship with the insurance company, the process of filing claims can be more tedious.

Benefit of Visiting Network Hospitals

Whether you’re opting for an individual health insurance, a family floater plan, or group medical insurance, it’s a good idea to check the list of network hospitals. The main reason is that the claims process for network hospitals is significantly faster and simpler than at non-network hospitals.

Smoother Process of Filing for Claim with a Network Hospital

If you visit a non-network hospital during a medical emergency, you will need to pay upfront initially. Once you have been discharged, you can file a claim with your health insurance provider and receive a reimbursement. 

Also, to file for a claim, you will require several documents, like medical certificate, diagnostic tests, invoices and receipts, medicine bill, etc. Some of these may not include the details needed by the insurer to approve your claim. Essentially, you will be coordinating between the hospital and the insurance company.

When you visit a network hospital, the process is much simpler. Even if you make the initial payment and file for claims later, the hospital is already aware of the various documents needed and the details to be mentioned in each document, as per the requirements of the insurer.

Cashless Facility with Network Hospitals

The main advantage of visiting a network hospital is that you don’t need to have ready funds to pay for your treatment upfront. You can simply inform your insurance provider and present your health card at the hospital. Following this, the hospital will directly coordinate with the insurance provider.  

For any planned treatment at your preferred network hospital, you may need to inform the insurance provider a few days in advance. For medical emergencies, you need to inform the insurer within 24 hours. All hospitalisation costs, including treatment, room rent, ambulance cost, and even food allowance for your attendant, will be paid by the insurance provider as per your policy terms.

Remember that some network hospitals may not have cashless facilities. Therefore, it is important to check the list of network hospitals and confirm which ones have cashless facilities in advance. This way, one can be well-prepared to tackle an emergency.

Team Finpage

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