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Network Hospitals & Non-Network Hospitals: Find Major Differences Between Them

Updated On Feb 12, 2021

In this day and age, getting health insurance is of utmost importance. An adequate insurance cover not just protects in medical emergencies, but also provides multiple tax benefits. Further, if the insurance company has a tie-up with a long list of hospitals in its network, getting cashless treatment becomes easier than never. The longer the network hospital list, the more convenience you will experience in finding one in the vicinity.

To help policyholders get treatment without burning a hole in their wallet, insurance providers analyse profiles and negotiate treatment with selected hospitals. By this way, the selected hospital becomes associated with the insurance company for a long-term basis and attain the esteem of a ‘network hospital.’

If you are wondering about network and non-network hospitals, then go through this article. In this post, we will discuss the differences between network and non network hospitals and throw light on how getting admission in a network hospital and a non-network hospital affects the policyholder:

Network Hospitals

Every insurance company in India has a tie-up with hospitals. They appoint a network of hospitals, medical professionals and clinics for cashless treatment. These hospitals charge a lower fee for hospitalisation. In lieu of that, hospitals get more patients who are channelled to them through the network of the insurance company.

The insured person files claims against their medical expenses and the insurance providers make substantial payouts to them. This is why insurance companies negotiate with the hospitals, reduce the medical costs and make them a part of their network.

When you are admitted to a network hospital, you don’t need to pay anything to the hospital. All the expenses (including before and after hospitalisation) are cleared by the insurance company.

To understand network hospitals, let’s me share an example:

Ravi is sick and has got admitted in a network hospital, which is in his vicinity. Since he has cashless insurance and is getting treatment in a network hospital, he is not required to pay hospital bills from his pocket as the third party administrator will help him and his family get cashless hospitalisation. Once Ravi gets discharged from the hospital, he needs to collect all the documents of the claim from the hospital for the future reference.

Non-Network Hospitals

It’s a kind of hospital, which is not in the panel of the health insurance company. When you get admitted to a non-network hospital, you’ll have to pay for all the hospitalisation expenses. After discharge from the hospital, you need to collect all the documents from the hospital and submit them to the insured.

The insurance company checks all the documents and approves whatever it finds reasonable. The amount is then refunded to the patient after 10-12 days. It’s important to note that those hospitals with no cashless facility have to go through the entire process, ranging from submitting medical bills and documentation even if he or she is admitted to a network hospital.

For example,

Ravi is sick. He has been admitted to a non-network hospital for treatment. The insurance company will not provide cashless treatment to him, irrespective of whether he has a cashless treatment facility in his insurance or not. In this scenario, Ravi has to submit all the relevant documents to the insurance company. And the insurer will reimburse all the treatment expenses (subject to the terms and conditions of the policy).

The Bottom Line

If you have bought a cashless insurance policy, getting treatment in a network hospital makes sense. It is good to have a list of best cashless network hospitals partnered with your insurance provider ready for an emergency. Go for non-network hospitals only when an emergency strikes or the treatment is not available in a network hospital.

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