When it comes to health insurance, policyholders need to understand the difference between network and non-network hospitals. Network hospitals work with insurance companies to provide cashless care to insured customers (policyholders). This means that the insurance company pays the costs directly to the hospital, reducing the patient’s financial burden. Typically, insurance companies provide a list of preferred network hospitals that provide efficient medical care with minimal paperwork.
In contrast, non-network hospitals have no such agreements with insurance companies. Although patients can continue to receive all treatments, they must initially cover all medical costs themselves. The insured can later request reimbursement by providing medical bills and other documents to the insurer.
“Choosing the right type of hospital can have a big impact on both the medical experience and cost. Therefore, policyholders should thoroughly check their insurance plan’s hospital network before opting for health insurance,” said Rakesh Goyal, Director, Probus.
Differences
When purchasing health insurance, the distinction between affiliated and non-affiliated hospitals has significant implications for processing medical bills. Understanding the contrast between the two can allow policyholders to make more informed healthcare decisions.
Goyal said, “Network hospitals are hospitals that have partnered with health insurance companies to provide cashless care to insured patients.” This means that a health insured person seeking treatment at a network hospital is not required to pay the hospital fees in advance . Instead, the insurance company pays the amount directly to the hospital. For example, if a person is admitted to a network hospital for surgery, the insurance company will cover the allowable costs, allowing the patient to focus on recovery rather than finances. In this case, the policyholder only needs to obtain pre-approval from the insurer to avail cashless treatment
Out-of-network hospitals
Non-affiliated hospitals, on the other hand, do not have an official agreement with the insurer. If an insured person is treated in a hospital, they must pay the entire amount upon discharge (payment). Later, individuals can file a refund claim with their insurance company. This process includes submitting all medical bills and other necessary documentation to the insurance company. “For example, if a person is treated at an out-of-network hospital, they may pay Rs 100,000 and then claim the reimbursement amount. However, depending on the insurance conditions, some costs may not be covered,” Goyal added.
It is important to note that if the policyholder is admitted to an out-of-network hospital, even if they use the cashless option, they will still need to be reimbursed. Depending on the hospital’s effort, the insurer may approve the claim in whole or in part.
Diploma
It is crucial for anyone with health insurance to understand the difference between network and non-network hospitals as this impacts both the treatment process and prices. “Network hospitals offer the significant advantage of cashless care, allowing patients to focus on their health rather than immediate personal expenses. The convenience of the insurer being able to settle the bill directly with the hospital, along with minimal paperwork, provides peace of mind during difficult medical needs,” said Goyal.
Non-network hospitals, on the other hand, require patients to pay for treatment in advance, which can be costly, especially in an emergency. While reimbursement is possible, it requires documentation and a waiting period and may not cover all costs due to insurance conditions.
Ultimately, choosing a network hospital whenever possible results in a more efficient and cost-effective care experience. While out-of-network hospitals offer more options in terms of location and services, they also incur upfront costs and delayed reimbursements. Therefore, policyholders need to familiarize themselves with their insurer’s hospital network in order to make informed healthcare decisions when necessary.
