What Are Network and Non Network Hospitals Under Health Insurance Plans?

Selecting a suitable health insurance policy is often regarded as a perplexing choice. With myriad plans that you can choose from, selecting a policy gets confusing. Multiple factors need to be considered before selecting the policy that fits you best. One such consideration is about network hospitals.

What are network hospitals?

When you buy health insurance, it has tie-ups with certain hospitals. This affiliation helps in speedy and cashless treatment for the insured. It aids the insured indirectly settling the treatment cost with the insurance company.

What are cashless claims?

Elaborating the above, cashless claim is the process where there is no outflow of money towards treatment cost. The insurance company pays directly to the hospital on your behalf. However, this cashless treatment facility is only available if treatment is availed at a network hospital. Although you must remember that the expenses within allowable limits only are covered by a cashless insurance claim. Any treatment sought from a non-network hospital shall be paid via the reimbursement of your expenses.

What is a non-network hospital?

A treatment facility that has no affiliations to the insurance company and is completely independent of the insurance company is a non-network hospital. Any treatment sought here is required to be repaid first after which an insurance claim is processed by the insurance company. You need to produce the invoice at the time of claim wherein after assessment of the reasonability of expenditure, the insurance company pays the claim. Apart from the bills, other documents like medical reports, test reports shall also be required.

What is the reimbursement method of claim?

When you avail treatment from a non-network hospital, the claim is paid via the reimbursement model. Here, you need to first repay all the treatment cost after which the supporting documents along with invoices of treatment are submitted to the insurance company. On the assessment of the validity of your claim, your insurance company make the payout.

Distinguishing highlights between network and non-network hospitals

Mode of payment: The mode of payment of claim at a network hospital is cashless if the policy terms specify it. On the other hand, any treatment availed from a non-network hospital, the insurance payout is by reimbursement of your expenses.

Association: All network hospitals are verified by the insurance company only after which they are added to the list of network hospitals. Since there is no affiliation in the case of a non-network hospital, there is no list of hospitals where the claim is prioritised by the insurer.

Final words

While selecting a policy, you can make use of a health insurance premium calculator. This nifty tool is commonly available on the insurer’s website for you to compare the available plans and select a policy that fits you the best. Moreover, adding the right add-ons while balancing the cost is also simplified using a health insurance premium calculator.

Understanding the meanings mentioned above, it is, needless to say, having a network hospital will benefit you largely. But considering the urgency and necessity of treatment, it should not solely be sought at a network hospital. Instead, prioritising the treatment is crucial and not the claim.