Cashless Network Hospital
Health insurance companies have a tie-up with leading hospitals across the country after checking their facilities, availability of doctors, quality of treatment offered, etc. These hospitals are known as network hospitals of a particular insurer.
These healthcare providers offer cashless mediclaim to policyholders. If you are admitted to any of the network hospitals, you do not need to worry about the treatment cost as your insurance company will directly bear the cost.
How Do Network Hospitals Work?
The insurance companies select the network hospitals based on thorough background checks, efficiency, and expertise of medical services offered. They renew their lists of network hospitals from time to time based on the quality of services they provide to the policyholders. This means that the tie-ups will not be renewed if the network hospital does not offer quality treatment.
The network hospitals selected by the health insurance companies offer cashless treatment to the policyholders. Cashless treatment can be availed for up to the sum insured limit and as per the terms and conditions of the policy.
Difference Between a Network Hospital And a Non-Network Hospital
Let us understand the difference between getting admitted in a network hospital and a non-network hospital and how it affects you, with the help of an example:
Scenario 1: Mr. Ram is unwell and has been hospitalised in a network hospital nearby his place of residence. But he does not have a cashless insurance facility. In this case, he can avail the required treatment at the hospital including costs related to the medical tests. He can then settle the bills out of his own pocket at the hospital. After Mr. Ram gets discharged, he will be required to submit a claim along with the required documents to the insurance company. The insurer, after verifying the documents, will approve the claim and Mr. Ram will get the amount spent on the treatment.
Scenario 2: Mr. Ram is unwell and has been admitted in a network hospital. He has the facility to avail cashless treatment at the network hospital. In this case, Mr. Ram need not spend the money out of his own pocket. This is because the Third Party Administrator (TPA) will help him or his family members avail the cashless treatment. At the time of discharge from the network hospital, Mr. Ram will need to take the documents related to the treatment from the concerned authority in order to keep record. He can then make a claim and the insurer will settle the medical bills directly at the hospital. Note that only the expenses covered in the policy will be paid for.
Scenario 3: Mr. Ram is unwell and has been admitted in a non-network hospital. Primarily, the insurance company will not cover him for the treatment, it being availed in a non-network hospital. So, Mr. Ram can avail the treatment and pay for it out of his own pocket. Later, he can make a claim for reimbursement and the company, after verification, will pay him for the treatment.
As the insurance company will verify the documents and only then reimburse the amount spent on the treatment, there are chances that the claim could get rejected. This may be due to the reason that the insurer finds the medical expenses to be greater than standard. In this case, the insurer might also just reimburse the amount that he finds reasonable. So, the bottom line is that a non-network hospital should only be an option in case of non-avoidable emergencies.
Let us understand the role of network hospitals in two conditions:
1. Planned Hospitalization
In the case of planned hospitalization in a network hospital, you will require to fill a pre-authorization form and submit it at the insurance desk of the hospital. Wait for it to get approved or rejected. If it gets approved, then the Third Party Administrator or TPA (the service provider with which your insurer has partnered) or the in-house staff of the insurer will sanction letter to the hospital and the hospital can start with the treatment.
2. Emergency Hospitalization
In case of emergency hospitalization, the same process of filling the pre-authorization form and getting Third Party Administrator’s approval is carried out. The TPA has to accept or reject a claim within 6 hours. In case you do not have time, you can pay in cash and seek reimbursement later from the insurance company.
It is the responsibility of the insurer’s representative or a Third Party Administrator to coordinate with the network hospital and settle all the claims, be it cashless or reimbursement. They communicate it with the patient, the hospital, and the insurance company to process the request.
The non-network hospitals or the hospitals which are not listed as network hospitals by the insurance companies do not offer cashless treatment. To avail treatment in such hospitals, you need to pay first out of your own pocket and can request for reimbursement later.
Advantage of Network Hospitals
At network hospitals, you don’t need to pay even a single penny out of your pocket to the hospital and yet you can get good quality treatment. It is less worrisome.
Whereas in the case of non-network hospitals, you have to pay the entire amount out of your own pocket and make requests for reimbursement later. Your request only gets approved if the insurance company finds it reasonable. This means, there is a risk involved in that case. While purchasing a health insurance plan, make sure you choose a policy with the most number of network hospitals near you.
Let’s give us a call at our toll-free 7551196989 to know the number of network hospitals of a particular insurance company or compare different policies and get the best quote. At InsuranceDekho, we can also provide you with assistance after the health insurance is purchased.
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Health Insurance Network Hospitals FAQs
What is a network hospital?
A hospital that has an agreement with the insurance company and offers cashless treatment to the insured is known as a network hospital. If you undergo treatment at a network hospital, then the insurance company will directly settle the bills for you.
Why do network hospitals play a very important role in health insurance?
Network hospitals make it possible for the insured to avail cashless treatment, which is the essence of a health insurance policy. If the insurance company has a good number of network hospitals near the insured individual’s residence, then he/she can easily avail cashless treatment without any hassle.
What are the benefits of preferred network hospitals?
You can avail several benefits on getting medical treatment at a network hospital. These include cashless treatment, easy access to healthcare, and easy cover for healthcare expenses.
What is the difference between a network and non network hospital?
Every insurance company offering health insurance has tie ups with hospitals where the insured can avail cashless treatment without paying anything at the hospital. These are known as network hospitals. All the hospitals other than the ones in this network are known as non-network hospitals, where the insured can only avail reimbursement treatment.
What is the difference between in-network hospitalisation versus non-network hospitalisation?
In case of network hospitalisation, the insured gets admitted in any network hospital by submitting the form to TPA for cashless mediclaim. If the cashless claim request gets approved, then the insured can avail treatment, the expenses of which will be borne by the insurance company. The insured will not be required to submit any bills. However, the insured will be required to only pay for the expenses that are not covered under the health insurance policy. Whereas in case of a non-network hospitalisation, the insured is required to pay for the complete treatment from their own pocket. He/she will be required to timely inform the insurer and submit the required documents within the stipulated time. If the claim gets approved, then the amount will be refunded to the patient.
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