Network and Non-Network Hospitals: Step by Step Guide

Network and Non-Network Hospitals

Network and non-network hospitals is crucial part of your health insurance policy. You must be aware that your insurer provides you cashless benefits under your policy or not. In order to provide a cashless claim, health insurance providers tie-up with certain hospitals.

You can get a cashless claim in case of network hospitalization. However, in the case of non-network hospitalization, first, you have to pay all the medical treatment expenses. Later you can claim it through the reimbursement process.

Network Hospitals

Health Insurers have a tie-up with a certain number of hospitals. If your insurer has network hospitals and you have the cashless benefits in your policy then you may get your claim on a cashless basis.

Let’s Understand with an example

Mr. Ashish purchases a health insurance policy 6 months ago. His policy provides cashless claim benefits. One day due to some medical emergency, he admitted to a network hospital.

His family contacted the hospital desk/TPA and process for cashless claim. The insurance company approved his claim as cashless. Mr. Ashish got required medical treatment from the hospital.

Network Hospitals 1

He didn’t pay money for medical expenses from his pocket. Mr. Ashish paid only some amount for administrative cost and non-disposable items only, which was not covered in the policy.

Non-Network Hospitals

Non-network hospitals are those hospitals where insurers don’t have their tie-ups. You can not get your claim on a cashless basis. In the case of hospitalization in non-network hospitals, you have to pay all the medical costs to the hospital. Later you file your claim on a reimbursement basis.

Let’s understand with an example:

Mr. Manish running his health insurance policy for 4 years. Due to some medical emergency, Mr. Manish admitted to a hospital for treatment. This hospital was not in the network list in his health insurance policy.

Means this was a non-network hospital. In this situation, he can’t get a claim as a cashless basis.

Mr. Manish paid all the medical expenses from his own pocket. He discharged from the hospital and come home. Later he filed a claim as reimbursement from his insurance company.

Non Network Hospitals

Insurance company, approved the claim and paid the claim amount to him. Insurer deducted the cost of disposable items because it was not covered in his health insurance policy.

Advantages of Network Hospitals

There may be following benefits insurer from the Network Hospital:

1- An insured person can get a claim on a cashless basis. Here insured can get a claim without paying medical treatment costs from his own pocket.

2- It is easy to process. There is no need to go for the reimbursement process to get the claim.

3- No instant financial burden on insured if he get cashless claim.

Why You Should Be Aware Of Your Network Hospitals Lists?

In my opinion, you should purchase health insurance which provides you cashless claim benefits. But is it enough?

No, It is not enough that your insurance company has tie-up with many hospitals and you have the cashless benefits in your policy.

You should also be aware that which hospital is in the tie-up with your insurer. In case of a medical treatment, if you have admitted to non-network hospital then what are the benefits of it.

Example: Mr. Ab is not well and doctor advice him to admit in hospital for a surgery. There were two good hospital near to his residence. He admitted in one hospital. He didn’t get cashless claim because this hospital was not in his networks list.

However, the second hospital was in the tie-up of the insurer and was in his network list. Mr. Ab admitted in the first hospital because he was not aware of his hospital network list. He didn’t confirm from the insurer also.

You should be aware of your hospital’s network list. You should know which hospitals are in tie-ups with the insurer in your residential area, your workplace, and in your city. Normally people prefer to get treatment in his nearby locations. You should have your hospital networks list handy.

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