Network Hospital vs Non-Network Hospital: Things You Must Know
Whenever you avail a best health insurance policy in India, policyholder may have come across two terms – network hospital and non-network hospital. Each of these options has its advantages and disadvantages, and on this basis, it is possible to choose the one that fits your pocket and health. Network hospitals allow cashless claim, whereas you will have to claim for reimbursement if you get treated at Non-Network Hospital.
In this blog, we will cover all the information that you would want to gather related to network or non-network hospitals present in India and how that impacts your health insurance policy.
What Are Network Hospitals?
A network hospital is the one that has tie-ups with your health insurance provider. These hospitals provide cashless treatment providers for policyholders as they are affiliated to the insurance company. This implies that you do not need to incur the cost of treatment as you are required to; the insurance company pays the hospital’s medical bill on your behalf. Typically you need to display your health insurance card or policy document and get prior authorization at the time of admission in order to avail cashless treatment.
Advantages of Choosing a Network Hospital
- Cashless Treatment: The biggest strength of going to a network hospital is the opportunity to avail cashless treatment. This indicates that you don’t have to stress over bearing hospital bills. This means once the insurance company is informed prior to admission, the insurance company pays the hospital directly, thus not burdening you with hospital bills during a health emergency
- Pre-Authorized Claims: Most of the insurance companies have prior authorization for treatments at an empaneled hospital. This helps to make sure the insurance provider approves your claim beforehand and the whole insurance claim process is seamless
- Wide Range of Hospitals: Today’s insurance companies have partnered with all the leading hospitals in country, to ensure that the insured receives quality health care. This can be especially advantageous if you require certain specialized treatment or procedures
- Transparency and No Hidden Costs: Network hospitals directly deal with your insurer so they do not charge you for additional services or inflate your bills
What are Non-Network Hospitals?
Non-network hospitals, on the other hand, are the hospitals which are not affiliated to your health insurance company. You will be required to bear all expenses incurred on treatment from non-network hospital, and later get a reimbursement from the insurance service provider.
Features of getting treatment in Non-Network Hospitals
- No Cashless Facility: The biggest disadvantage of going for a non-network hospital is that cashless treatment facility is not available. This means that all the charges are required to be paid to the hospital in advance and then you will have to file a claim for reimbursement
- Reimbursement Delays: The reimbursement process for out of network hospitals is sometimes little more complex. Insurance companies will ask you to attach other documents, bills, and forms, and the whole process of approval may take time. The claim settlement takes about 10 to 12 days or more
- Lower Claim Amounts: Although you will be paid back for your treatment in a non-network hospital, the insurance firm may not repay the full charges. In some cases, the insurance company is likely to make a payment limit which might be below the amount that you have paid for the treatment.
- Higher Out-of-Pocket Costs: Because the rates in non-network hospitals are not regulated with the insurance companies, it is quite possible you may receive higher medical bills compared to network hospitals. On the same note, there are some things that the insurer may not cover including procedures and costs when the hospital is out of network.
- Paperwork: You will have to submit all the proofs, medical records, bills, and lab results to get a claim which may be a bit complex.
Factors to consider before choosing Network or Non-Network Hospitals
- Urgency and Emergency Situations: In an emergency it is possible that the choice of a hospital may not be available to you. In such circumstances, you have to seek the service of the nearest hospital even if it outside the network.
- Cost Considerations: If your main criteria are to pay as little as possible out of your own pocket than network hospitals will be preferable. They help you avoid being overcharged especially through hidden charges since most of the payment is done with the insurer directly. But if you are ready to file a reimbursement and they have enough money to pay for the treatment, they can go to a non-network hospital which may cost lesser than the network hospitals conducting the same procedure
- Quality of Care: Most network hospitals are well-established and provide quality medical amenities to their fellow networks. Nevertheless, there could be some non-network hospitals that may equally well or even better perform in treatment procedures. Before choosing a non-network hospital, it is always possible to research for the quality of treatment available
- Insurance Policy Terms: The major or primary aspect that one should need to consider on health insurance policy is the differences of coverage of network and non-network hospitals. Many policies may have a higher claim limit when they are treated in network hospital, while some of them may have a partial reimbursement on non-network hospitals
Conclusion
Both network and non-network hospitals have their share of pros and cons. Network hospitals offer the convenience of cashless treatment, quick treatment, and transparent billing; on the other hand, non-network hospitals may offer more flexibility, in terms of treatment offered and choice.
Prior to choosing one among the two, it’s essential to weigh the urgency of your medical condition, consider costs, and flexibility. Fincover.com, India’s leading online insurance aggregator offers a platform to compare multiple insurance policies at one place. You can take advantage of that feature and take a well-informed decision.
