What are Network Hospitals and Non-Network Hospitals?

Network hospitals
Network hospitals and Non-Network Hospitals

Network hospitals and non-network hospitals are crucial parts of your health insurance policy. You must be aware that your insurer provides you with 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. There are many health insurance companies in India and they have their own network hospitals.

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Network Hospitals

Health Insurers have 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 was admitted to a network hospital.

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

He didn’t pay money for medical expenses from his pocket. Mr. Ashish paid only some amount for administrative cost and some items only, which was not covered in the policy. So, you can clearly see that he got the claim on a cashless basis and he didn’t need to pay the whole amount from his own pocket.

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 to your health insurance company.

Let’s in detail with understand with an example:

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

This means this was a non-network hospital. In this situation, he can’t get a claim on a cashless basis. Mr. Manish paid all the medical expenses from his own pocket. He was discharged from the hospital and come home. Later he filed a claim as reimbursement from his insurance company.

The insurance company approved the claim and paid the claim amount to him. The insurer deducted the cost of disposable items because it was not covered by his health insurance policy.

Advantages of Network Hospitals

As I explained above, there is a big difference between a Network hospital and a non-network hospital. Here are some of the following benefits from Network Hospitals which a policyholder gets.

1- In the case of network hospitalization, 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.

network hospitals list
network hospitals

2- It is an easy and quick process for policyholders. There is no need to go through the reimbursement process and get the claim from the insurance company later.

3- No instant financial burden on the insured if he gets a cashless claim. But in the case of non-network hospitalization, first, you need to pay hospitalization and treatment cost on your own. And later you can file the claim through the reimbursement process. It takes some time to process and give you the claim amount.

Why You Should Be Aware Of Your Network Hospitals Lists?

In my opinion, you should purchase health insurance that provides you with cashless claim benefits. But is it enough? No, It is not enough that your insurance company has a tie-up with many hospitals and you have the cashless benefits in your policy.

You should also be aware that which hospitals are in the tie-up with your insurer. If the good hospitals near your residence, office, and the hospitals where you mostly prefer are on the list, it is good.

network hospitals tieups
Network hospitals – Claim

In the case of medical treatment, if you have been admitted to a non-network hospital then what are the benefits of cashless facilities? Let’s understand it with an example.

Example: Mr. AB is not well and the doctor advised him to admit to the hospital for surgery. There were two good hospitals near his residence. He was admitted to one hospital. He didn’t get a cashless claim because this hospital was not on his network hospitals list.

However, the second hospital was in the tie-up with the insurer and was on his network list. Mr. Ab was admitted to the first hospital because he was not aware of his hospital network list. He didn’t confirm from the insurer also. So, it is also important that you know which hospitals are in the network hospitals.

I would suggest that you should confirm whether the particular hospital is in the tie-up of your health insurance company or not. From time to time, insurance companies may review the hospitals and may add some new hospitals to the list and may also remove them from the list. So, you must confirm it at the time of need.

Conclusion – Network Hospitals

You should be aware of your network hospitals 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 their nearby locations. Whether you purchase your health insurance policy from Bajaj, ICICI, HDFC, or any other company, You should have your network hospital networks list handy. If you can’t keep the network hospital list, you can ask customer care also to know whether a particular hospital is on the list or not.

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