The Difference Between Network and Non-Network Hospitals

Obtaining a health insurance policy in today’s date has gained utmost importance, for they not only protect individuals during medical emergencies but also offer multiple tax benefits. Moreover, if your insurance provider has tie-ups with a list of hospitals, the process of getting treated becomes smoother.

In order for expenses to stay within an individual’s budget without burning a hole in their wallet, insurance companies analyse profiles and negotiate treatment with chosen hospitals. Thereafter, the hospitals that have been selected by the insurance provider become associated with them on a long-term basis and thus, attain the esteem of a ‘network hospital’.

Let us take a look at how being admitted in a network hospital and a non-network hospital affects the policyholder:

1st Scenario: Mr. Samarth is sick and has been admitted in a network hospital which is in close proximity to his place of residence. However, Mr. Samarth does not have the facility of a cashless insurance. In such a case, the individual can avail complete treatment including the costs of tests that are required. Once the treatment in the network hospital is over, the individual will be required to settle the account with cash from his own pocket. Once Mr. Samarth gets discharged from the hospital, he will be required to submit the claim invoices/receipts along with the necessitated documents to the insurance provider. Once the claims have been approved, the amount spent on the treatment will be reimbursed to Mr. Samarth’s account.

2nd Scenario: Mr. Samarth is sick and has been admitted in a network hospital along with a cashless insurance, which is close to where he lives. In such a case, the individual (Mr. Samarth) will not have to spend money from his pocket, as the third-party administrator will help him and his family members avail the facility of cashless hospitalisation. Once the individual gets discharged from the hospital, he will be required to carry the documents of the claim, to keep a track of records in the future. The benefits of health insurance policies can be extended, however, components that are not included in his/her policy will be the only expenses incurred by him.

3rd Scenario: Mr. Samarth is sick and has been admitted in a non-network hospital for treatment. Primarily, the insurance provider/insurer will not cover this treatment, irrespective of whether the individual has a cashless insurance or not. In a typical scenario, if an individual is getting treated in a non-network hospital, he/she can get the total cost reimbursed from the insurer after having paid for it himself.

However, the insurance company will perform a detailed analysis of the costs before reimbursing. Therefore, there is a good chance that Mr. Samarth’s claim (in the third scenario) might get rejected altogether if the insurer finds the medical costs to be higher than standard market prices. The insurer may partially approve the claim, adhering to only those costs that are reasonable according to their policies and discretion.

The scope of a health insurance policy is extensive and one must know how to make the best of a health cover. In the third scenario, Mr. Samarth is rendered incapable from making the most of the benefits offered by his health insurance policy as he chose to get admitted in a non-network hospital.

Tips to Choose a Network Hospital for Every Treatment:

  • Conduct accurate research and make a list of all the network hospitals operating in your area or an area in close proximity.
  • In case of a pre-planned hospitalisation, the third-party administrator can be contacted in prior for all necessary approvals.
  • In case of an unplanned medical emergency, the list of network hospitals you have researched will come in handy to make the best of your medical cover.

The primary objective of an insurance provider is to cover individuals during medical contingencies, however, they seek profits as well. Services offered by a network hospital ensure just that and also help you save large portions of your disposable income.

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