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Understanding Network Hospitals Vs Non-Network Hospitals In Health Insurance

When reading your health insurance policy, you might come across certain terms that leave you confused. In such a situation, it is always better to get clarity on the parts you do not understand. Getting a proper explanation of your policy will help prevent any confusions that may arise during a claim.

Among the most common queries people have about health insurance, some of the most frequently asked questions concern the differences between network and non-network hospitals. In this article, we will take you through a basic understanding of network vs. non-network hospitals in health insurance.

What are network and non-network hospitals?

An insurance company creates tie-ups with certain hospitals and includes them in their network. These hospitals offer lowered charges for treatment to policyholders of that insurance company. In return for these lowered charges, the hospitals do benefit by getting an assurance that policyholders would prefer treatment at their facilities as opposed to other hospitals. This assurance comes because network hospitals generally offer cashless treatment to policyholders from the insurance companies they are associated with.

Any hospital that does not form a part of this tie-up with an insurance company is a non-network hospital. This non-network hospital might be a network hospital with another insurer.

How does the choice of hospital affect a claim?

If a patient goes to a network hospital, their health insurance claim will fall in either one of the following two situations:

Situation 1- Network hospital with cashless claim

If you go to a network hospital that offers cashless facility, you do not need to spend anything from your own pocket for the treatments included in your policy. Everything that your policy covers will be directly settled between the insurer and the hospital. You may need to inform the insurer before getting hospitalised.

Situation 2 – Network hospital without cashless claim

If you do not have the cashless facility in your policy, you may get admitted to a network hospital and benefit from their rates that have been negotiated with your insurer. You can then collect the bills and submit them to your insurance company for reimbursement.

Now, let’s look at situation 3 with a non-network hospital.

Situation 3 – Non-network hospital

If a patient goes to a non-network hospital, they may still collect all the bills and request for reimbursement. But since the insurance company has no tie-up with the medical centre in question, the payout could only be done for the charges deemed as reasonable. Remember that as a non-network hospital has no tie-ups with the insurance company, the charges for several treatments would probably be much higher here as compared to a network hospital. Thus, you could probably end up getting a much lower reimbursement on your health insurance claim as compared to going to a network hospital.

In conclusion

Thus, as we can see, it would be wise to seek treatment from your insurance provider’s network hospitals. Doing this would enable you to truly enjoy the benefits of your health insurance policy, such as cashless claims. Go to a non-network hospital only if you absolutely must in a situation of an emergency where there is not time to check for network hospitals in your area.

We hope this article helps you. Take care.