4 Differences Between Network And Non-Network Hospitals

Over the past few years, medical expenses have witnessed a sharp rise. With this increase, having health insurance becomes an absolute must as health insurance helps policyholders to pay for expensive medical bills and most importantly get quality treatment. In order to make it easier for policyholders to avail treatment, health insurance companies have also tied up with certain hospitals known as network hospitals. On the other hand, there are non-network hospitals too, so let’s understand how a network hospital is different from a non-network hospital.

Understanding Network And Non-network Hospital With An Example

Before we dive into the differences between network and non-network hospitals, let us first understand what exactly they mean with an illustration:

Network Hospital

In health insurance, network hospitals refer to the hospitals with which a health insurance company has partnered. A health insurance provider has tie-ups with a range of hospitals in different Indian cities so that you can easily avail of medical treatment at your respective location. The greater the number of network hospitals provided by your insurer, the better it is for you as a policyholder. 

Illustration: Mr. Agarwal is diagnosed with an illness that requires immediate medical attention. He checks the list of network hospitals available in his neighbourhood and makes a visit accordingly. On visiting the network hospitals, he just needs to get in touch with TPA who will help him understand how to avail cashless treatment at the network hospital. Once he completes all the processes and submits relevant documents, the treatment will immediately start. When he is seeking treatment at a network hospital, he need not submit any medical bills, as the insurance company will directly settle the bills upon verification from their end. Thus, without having to worry about arranging cash, Mr. Agarwal will be able to get immediate medical care at a network hospital.

Non-network Hospital

Non-network hospitals on the other hand are non-partnered hospitals. These hospitals are not mentioned under the health insurance contract signed between an individual and an insurance company. This means that in a non-network hospital, you cannot take the advantage of getting cashless treatments.

Illustration: Mr. Agarwal has been diagnosed with heart failure and requires urgent treatment. He is unable to find any network hospital in his region and thus makes a visit to a non-network hospital. At the non-network hospital, Mr. Agarwal will have to pay for all the medical bills, and only then can he avail of the treatment. After treatment and getting discharged from the hospital, he gathers all the medical bills and other relevant documents so that he can get the amount reimbursed from his health insurance provider. Once the health insurance company verifies all the bills, Mr. Agarwal can get his claim settled and receive reimbursement based on the sum insured by him. 

Differences Between Network And Non-network Hospital

Enlisted below are some of the basic parameters that help in identifying the difference between a network and a non-network hospital:

1. Cashless Treatment Facility

A cashless treatment facility is one of the major perks that health insurance companies now provide. With a cashless treatment facility, your bills can directly be settled by an insurance company without you having to spend any money from your pocket. Cashless treatment is a major parameter that differentiates a network hospital from a non-network hospital as it is only at the network hospital where this facility can be availed. At a non-network hospital, you can only file a reimbursement claim, meaning after you have paid for the medical bills, you need to submit those bills to your insurer in order to get the amount reimbursed. 

2. Waiting Time

In the case of a network hospital, the waiting time is almost negligible. The moment the TPA at a network hospital verifies all the necessary documents, the medical bills will be directly settled without any waiting time. On the other hand, at a non-network hospital, it is only after submitting the medical bills, can the policyholder seek reimbursement. The reimbursement only happens once all the bills are verified and this usually makes the waiting time for claim settlement longer.

3. Documents

When it comes to getting your health insurance claim settled, it is very important to keep your documents safe especially when you are availing treatment at a non-network hospital. This is because, in the case of non-network hospitals, you need to ensure all your medical bills are safe otherwise the claim might get rejected. The process of documentation at a non-network hospital is also quite cumbersome. On the other hand, at a network hospital, once you submit the health insurance copy and other documents, the TPA will be responsible for everything else and make the process hassle-free for you. 

4. Cash Arrangement

One of the most important differences that you should consider when choosing between a network and a non-network hospital is that in the case of a non-network hospital, you need to arrange cash immediately for the treatment to get started. However, this is not the case at a network hospital, as the insurer directly settles the bill from their pocket. 

Conclusion

Thus, in a nutshell, before buying any health insurance plan, make sure to understand everything about network and non-network hospitals. Although a network hospital has its own advantages, it doesn’t in any case implies that your treatment will be compromised at any other non-network hospital. So, based on your requirements, pick any from the network or non-network hospital.

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Disclaimer: This article is issued in the general public interest and meant for general information purposes only. Readers are advised not to rely on the contents of the article as conclusive in nature and should research further or consult an expert in this regard.