What are Network Hospitals in Health Insurance?

If you’ve purchased a health insurance policy, you would have seen and heard the term ‘network hospitals’ mentioned in your policy document. What do network hospitals mean?

Network Hospital Meaning in Health Insurance

With regard to health insurance, the term network hospital in health insurance refers to tie-up or affiliation with your particular insurance company for providing cashless hospitalization treatment to the insured (who decides to buy health insurance from the particular insurer). The said insurance company promises to its policyholder that he/she would be able to enjoy quality treatment at one of the network hospitals without the need to pay any cash at the time of admission to the hospital.

What Does a Network Hospital List Contain?

When someone purchases a specific health insurance plan from an insurance company, the latter issues them a list containing the names of all the network hospitals that are in agreement with that insurer. This list can also be found on the insurer’s web portal, which the policyholder can easily access in time of need. Here, one can find all the hospitals where the insured can avail cashless treatment facility in time of emergency. All hospital bills would later be settled by the insurer.

Note that the cashless hospitalization facility is only available at the hospital mentioned in the list of hospital network, as provided by the insurer.

How are Network Hospitals Selected?

Your insurer conducts a thorough background check on each hospital that it selects for empanelment. Each hospital is tested for efficiency as well as expertise in the particular area of services that it provides. Based on these criteria, the insurance company may also change or renew their network hospital list from time to time. In case a particular hospital on the insurer’s network fails to deliver quality service, it would be removed from the list.

How do Network Hospitals Work?

The role of network hospitals arises in two situations – Planned hospital stay by the patient and Unplanned or Emergency Hospitalization need. Let us now understand how network hospitals operate in both these cases:

Planned Hospital Stay: In case you already knew when and for how long you’d need to be hospitalized for a specific treatment, you can easily avail cashless hospitalization at any of the nearest network hospitals. At the time of admission, the hospital would ask you to fill out a pre-authorization form. This form intends to seek approval of the insurance company to commence cashless treatment for the patient.

You can submit this form at the hospital’s insurance desk for approval. In case it is approved, your insurer would notify the hospital to proceed with the treatment without having you to pay any expenses.

Emergency Hospitalization: The same process of seeking approval through the pre-authorization form is followed in this case as well. Note that the insurer would have to either approve or reject a claim within 6 hours so that the patient’s treatment can be started ASAP. In this case, if you feel that there isn’t enough time to wait for approval, you may choose to pay the hospital in cash and then claim for reimbursement from the insurer later.

In both the above cases, all settlement of hospital bills for the patient as well as reimbursement claims later are settled only by the insurer since the insured patient took treatment at a network hospital of the insurance company. This also means that the facility of cashless treatment would not be available at any other hospital other than the ones mentioned in the insurer’s network. So make sure that you choose your hospital carefully or be prepared to spend first from your own pocket and seek reimbursement later.

Benefits of Treatment at Network Hospitals

There are several advantages of opting for treatment at your insurer’s list of network hospitals. Some of the top ones are mentioned below:

• The best advantage of availing treatment at a network hospital is that the insured does not need to spend from their own pocket to bear the hospital expenses. All your hospital bills would be borne by the insurer and settled directly with the network hospital. This also means that you can choose to get the best quality treatment at the hospital without worrying about its cost.
• There is no risk of claim rejection involved in the case of network hospitals because the latter has already agreed to provide cashless treatment to the insured without any condition. On the other hand, if you choose to receive treatment at any other hospital not in the insurer’s network, you would need to pay first and then file a claim for reimbursement. There’s always the risk of rejection involved in this case, if the insurer does not find the claim to be reasonable.
• Network hospitals are spread out all across the country. This means that you can choose the one that is nearest to you in time of medical need and opt for quality service and treatment, all cashless. This keeps the whole process less stressful for the patient.

How to Choose a Network Hospital Online?

Your insurer would generally provide you with a list of its empaneled or network hospitals at the time of handing over the health insurance policy documents. However, you can also select a network hospital online, in case of an emergency, to find out the service nearest to you for ease of convenience.

Just visit your insurance company’s website and enter your state and city in the space provided on the network hospitals page. You can also choose for a specific type or grade of hospital or a particular specialty that it has expertise in, based on your requirement.