Difference Between Network And Non-Network Hospitals

4 min read

Health insurances serve the best purpose, especially at the time of a medical emergency. Health insurances provide cover for varied medical purposes and support an insured person financially. Benefits incurred from a health insurance cover range from hospitalization costs, private room charges, domiciliary charges, inpatient charges, ambulance charges and so on.

Different health insurance providers offer different health cover and a policy owner has the right to choose the best policy provider depending on the coverage and benefits they offer. Thus, it is advisable for the consumers to analyze the benefits offered in terms of the requirements before buying an insurance. Here, factors like age of the insured person, past health history of the person, diseases already suffering from, financial situation of the person, etc. needs to be considered.

Also, depending on your need you can even choose between a policy offering cashless settlement of claims or reimbursement of claims. In case of cashless claims, you can avail the facility if you get your treatment done in any of the network hospitals of the insurance company. But in case of reimbursement claims, you can avail the facility by getting treatment at any hospital of your choice.

Since network hospitals are linked with your insurance providers, they can clear your medical bills by directly making the payments to the network hospital without your much involvement. Thus, you won’t have to worry about paying the money from your pocket or of any other hassle.

In this blog, we will talk about the Network and Non-Network Hospitals and inform you about their differences to allow you to know your policy better.

Also Read: Is Health Insurance Important for Women?

What are network hospitals?

The group of hospitals that are allied with your health insurance company are called as network hospitals. You can avail the facility of cashless claims from your insurance provider in any of the network hospital list mentioned in the website of your insurance company.

Here are the steps to avail cashless claim benefit from your policy holder:

  • Each health insurance company has a large network of hospitals. So, choose a hospital that is enlisted in the network of hospitals of your insurance provider.
  • You can avail the benefit of cashless claim at the hospital after showing a health card offered by your insurance provider.
  • The hospital list serve as an important factor that influences the choice of policy owners while selecting a policy provider.
  • Choosing to get treatment at a network hospital is necessary since your hospital bills are directly cleared by the insurance provider in the network hospitals.
  • Thus, it saves your involvement and make process fast and hassle-free.

What are non-network hospitals?

Non-network hospitals are the regular hospitals situated in your city or across the country, which are not mentioned in the hospital name list of the network hospitals of your insurance company.  You can avail treatment at any such non-network hospitals. But in this case, you have to pay the bills on your own. Later you can claim reimbursement for the treatment from your policy provider. The amount reimbursed is received in your registered bank account. A person with money in hand and who can pay the medical bills on their own at the time of discharge can get treatment at a non-network hospital. Also, in case of an unavoidable situation, you can go to a non-network hospital. In other cases, it is better to go to a network hospital so that you can claim cashless and hassle-free claim benefit.

Differences between Network and Non-Network Hospitals

Network and non-network hospitals differ in three basic factors. They are:

  • Procedure/Formalities
  • Payments
  • Reimbursement Period

Let’s see the points in detail:

Procedure/Formalities – The procedure or the paperwork required in the network and non-network hospitals varies. In non-network hospitals, you need to fulfill numerous formalities including form fill-up, paperwork, form-submission etc., while in case of network hospitals, you can make cashless claims where the payment will directly reach the hospital account. Moreover, the settlement of claims in network hospitals is faster as compared to non-network hospitals.

Payments – In non-network hospitals, you must pay the bills at the hospital where you are undergoing treatment at the time of discharge and can make the claim for reimbursement from your policy provider later. Here, the amount will be transferred in the registered bank account of the policy owner within 2-3 working days. However, in case of network hospitals, you can make cashless claims and your medical bills will be cleared directly by the insurance company.

Reimbursement Period – The waiting time for getting a payment cleared in case of a network hospital is just hours. Once you file a request to settle a claim in a network hospital, it is done within a few hours by the insurer after the verification is done. Here, the claim amount is directly provided to the network hospital as they directly clear the dues.

This is not the same in case of non-network hospitals because non-network hospitals take at least 2-3 working days to reimburse your claim. Once you submit the documents and it gets verified by the company, they transfer the amount into your official bank account registered with the insurance company.

Also Read: No-Claim Bonus in Health Insurance

Conclusion

Looking at the present situation, it is evident that a health insurance is the need of the hour in the current time for each and every individual. However, to choose the best insurance policy, you must compare different factors really carefully before selecting the final product. Here, it is better to opt for a policy offering cashless claim at a network hospital since it allows quick and efficient payment. Also, you can avoid many hassles, especially during a medical emergency with a cashless claim.

On the other hand, you can even choose a non-network hospital and claim reimbursement later if you have cash or if there is any urgent situation where you must go to a non-network hospital to fulfill the medical need.

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Gayatri Prabhu, Head-Digital Business at Mahindra Insurance Brokers Limited (MIBL) is one those few digital leaders who has the width and depth that is required to execute an ROI driven holistic digital strategy. She cuts through the noise, identifies the critical levers and leads her team to successful execution of the defined strategy. Her core mantra to win new and retain existing customers is: understand the consumer behavior and craft experiences around it.

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