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Network vs Non-Network Hospitals - Impact on Health Insurance Claims
Aug 5, 2022

How Do Network & Non-Network Hospitals Affect Your Health Insurance Claims?

A medical emergency is one of the few uncertainties of life that we all need to be prepared for. This preparedness can be in terms of ensuring whether the right treatment is available and whether we have financial coverage for such treatment. A health insurance policy is a smart way to ensure that the right treatment is available, without having to worry about its treatment cost. Among the different benefits health insurance in India offers, cashless treatment is a noteworthy feature. This means you can not only avail the right treatment when needed but also not pay for it. But this is possible only at a network hospital. This article helps to distinguish between what a network hospital and a non-network hospital are and how it impacts the insurance claim process. Continue reading to know more.

What are network hospitals?

Network hospitals are all those medical facilities that are associated with the insurance company by way of a tie-up. This tie-up with the insurer helps the policyholder avail of fast and cashless treatment at a network facility. Thus, cashless medical treatment is one of the greatest benefits for a policyholder when a network hospital is opted for. *

What is cashless health insurance?

Cashless health insurance is a process where a minimal outflow of money is required towards eligible treatment costs. This minimal amount that you need to pay is by way of the deductibles and other costs generally covered by the insurer. To avail the facility of cashless health insurance, you need to ensure that the treatment is sought only at a network hospital. Further, the medical expenses that will be covered must be as per the policy’s terms and conditions. *

What are non-network hospitals?

Contrary to a network hospital, a non-network hospital is the one where the medical facility has no tie-up with the insurance company. Thus, no additional benefits are available to the policyholder when treatment is availed at such a hospital. When treatments are sought at a non-network medical facility, the claims are only paid via reimbursement to the policyholder. *

What is a reimbursement claim?

Claims where you, the policyholder, are required to pay for the treatment cost first, which are then subsequently compensated by the insurer, are called reimbursement claims. These claims need to be submitted to the insurer for verification with the necessary medical bills. Only after the insurance company validates these medical expenses to be in line with the insurance policy’s terms, the compensation is paid. *

Impact on an insurance claim

A claim made at a network hospital can be made on a cashless basis where you need not worry about paying the majority of treatment costs. In case of a planned medical procedure, approval must be sought from the insurance company, after which the cost of your treatment is covered by the insurance plan. For emergency treatments, the hospital reports the same to the insurance company, which then pays for your treatment. Unlike claims at network hospitals, a reimbursement claim is required to be raised for any treatment availed at a non-network medical facility. The claim to be settled depends on the medical bills you provide as evidence to the insurer, subject to its verification. Also, there is a longer time lag in processing a reimbursement claim, since the verification of medical bills is a crucial step for the insurance company. * * Standard T&C Apply With the above claim procedures described, it would be best to opt for treatment at a network hospital as it eliminates the burden of financial stress. A wider network of such hospitals comes in handy, especially when shortlisting health insurance plans for family, as different types of treatments can be availed for beneficiaries of different age groups. Insurance is the subject matter of solicitation. For more details on benefits, exclusions, limitations, terms and conditions, please read sales brochure/policy wording carefully before concluding a sale.  

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