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.
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