Things to Consider About Cashless Network Hospitals in India

In recent times, cashless health insurance has become a norm of sorts and we have grown used to the convenience it offers. Cashless, as the name suggests, is a provision in Mediclaim policies where users can avail services without having to pay, as the bills for treatment are settled by the insurance company directly with the hospital. Of course, there are limits to the coverage to the Sum Insured amount. Additionally, the cashless facility works seamlessly with the Network Hospitals that the insurer has tied up with.

What Are Network Hospitals?

Network Hospitals are designated hospitals with which an Insurance Provider has a tie up. For example, I have a Mediclaim policy with Company X, in my city out of 10 hospitals, 7 have tied up with my insurer X to provide cashless treatment to me in case I need to avail hospitalization. These 7 hospitals would be known as network hospitals for my insurer X. Likewise, all across India, in different cities, there would be hospitals that my insurer has tied up with, and they would all be part of my insurer’s hospital network where I can avail a cashless treatment facility (some exceptions of Zone may apply). 

That raises a question about the hospitals that are not part of my insurer’s network. Can I avail treatment in those “non-network” hospitals, the 3 out of 10 in my example above? The answer is, I can. However, that would not be a cashless hospitalization rather on a reimbursable basis, that is I would need to make a payment first and then claim the amount from my insurer, afterwards. Naturally, this is a hassle for me as I need to have a lot of cash to be able to pay for my treatment, in case it is expensive, in order to settle the bills before getting discharged. 

Advantages of Cashless Hospitalization in Network Hospitals

Insurance companies provide certain benefits to the policyholders who get treated at network hospitals. These advantages would include the following:

1. No payment required (based on sum insured, sub-limits etc.)
2. Often, no paperwork 
3. Usually large network of hospitals
4. Benefit available across the country (with some restrictions on zone)
5. Assurance of certain level of service due to participation in Network programme

Most of us are aware of the advantages of cashless hospitalization and would, perhaps, agree that nothing beats the convenience of this provision, but there are cases when we either need to or wish to avail treatment from a non-network hospital.

Planned Treatment From a Non-Network Hospital

There are cases when certain specialized treatments, or the specialists renowned for certain procedures are available in hospitals that are not part of the insurance provider’s network. In such cases, an approval and authorization for the treatment needs to be obtained in advance from the insurance provider to avoid hassles with claim settlement later. As mentioned earlier, there could be co-pay in such cases, and insured individuals must compare overall costs before opting for a non-network choice. 

Emergency Hospitalization in Non-network Hospitals

In case of an accident or an emergency situation where a network hospital is not available, patients need to update the insurance provider within 24 hours of hospitalization (can be done by someone on behalf of the patient in case the patient is not in a position to do so). This helps the insurance provider work with the hospital directly. Insurance companies may be able to extend their services in a way that is convenient for the insured/patient in case of emergencies.

Conclusion

Cashless Hospitalization in a Network Hospital is a convenient facility provided by insurers. Mediclaim policy holders can benefit from comparing the networked hospitals across policies to ensure that their preferred hospital is covered by the insurer. In some cases, new hospitals are added by insurers on the recommendations of their policy holders after performing due diligence. Hence, policy holders are advised to take advantage of this provision, whenever necessary, in the most beneficial manner.

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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.