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Difference Between Network and Non-Network Hospital

Network hospitals refer to empanelled hospitals where you can avail yourself cashless treatment facilities. Hospital expenses are reimbursed later in a non-network hospital.

  • 17 Jun 2022
  • min read
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Spike in medical inflation has significantly pushed up hospitalisation expenses, making health insurance an absolute must. Knowing about the list of network hospitals is among the several things you must consider while buying a health plan. There are several benefits on offer while undergoing treatment in a network hospital.

However, that doesn’t mean that you can’t avail of treatment in a non-network hospital. It’s essential for you, as a policyholder, to understand the difference between network hospitals and non-network hospitals so that you can make a prudent choice when the need arises. This article aims to decipher the differences between the two on different parameters. Let’s get started.

Meaning of Network Hospitals in Health Insurance

Network hospitals in health insurance refer to hospitals and clinics with which your health insurer has a collaboration, and these hospitals are on the empanelled list of your insurer. Every health insurer has a tie-up with different hospitals (in your state and outside), clinics, and treatment care centres.

These are known as network hospitals with which your health insurance company has a contract. When you get admitted to any network hospital, you are eligible to receive cashless treatment facilities, subject to the policy’s terms and conditions.

Meaning of Non-network Hospitals in Health Insurance

Non-network hospital means hospitals, clinics, and treatment centres that are not on the empanelled list of your health insurance. In other words, your insurer doesn’t have a collaboration with them. If you end up hospitalised in a non-network hospital, you can’t avail cashless treatment facility.

Though every health insurance company strives to have an extensive network of hospitals, some are left out. No health insurance company can have a tie-up with all the hospitals and medical treatment centres present in the country. However, leading hospital chains and reputed clinics are on the empanelled list of health insurance companies.

Parameters on Which Network and Non-network Hospitals Differ

1. Cashless Treatment Facility

Cashless treatment facility is one of the fundamental differences between a network and a non-network hospital.  It essentially means that you don’t have to end up paying upfront when you are hospitalised in a network hospital. Inform your insurer about hospitalisation and submit the relevant documents to the third-party administrator (TPA).

In a network hospital, your insurer directly settles hospitalisation expenses incurred. However, the case is different in the case of a non-network hospital. When you get yourself treated in a non-network hospital, you have to make payments upfront.

Once you are discharged, you need to submit the relevant bills and reports to your insurer. After due diligence, the insurer reimburses you the hospitalisation expenses incurred based on the policy purchased by you.

2. Documentation and Formalities

Documentation and formalities are a straightforward process in a network hospital. Present your health card to the TPA (third-party administrator), get in touch with your health insurer, and you are done. They take the process forward. You don’t have to undergo the cumbersome process of keeping all documents, including doctor’s reports, bills, etc to claim your insurance.

However, things are different in a non-network hospital. You have to keep all the documents carefully as misplacing them can lead to claim rejection or being reimbursed a lower claim amount. If you happen to lose any document, arranging a duplicate for the same can be challenging. This will also delay the claim settlement process.

3. Cash Arrangement

When you get treated in a network hospital, you don’t have to worry about cash arrangements. As said, everything is cashless. However, if you get treated in a non-network hospital, you may need to deposit some cash upfront for admission. Also, you need to make regular payments during the course of treatment, which can be pretty challenging.

During testing times such as these — when income is under stress due to the COVID-19 pandemic — arranging and paying cash in short intervals can be an uphill task. In such situations, you may end up borrowing money on high-interest rates that can further dent your finances.

Also read:

When to Seek Treatment in a Non-network Hospital?

As evident, seeking treatment in a network hospital is far more convenient than a non-network hospital. However, there are times you have no option but to get admitted to a non-network hospital, and you should opt for it only when there’s no choice at your disposal. 

Equally essential is to make sure that you keep all the documents, including bills, reports, discharge slips, etc., safely to ensure smooth and hassle-free claim settlement. It’s advisable to store them digitally so that you can find them easily, even if they get misplaced.

In conclusion

While buying health insurance, you must go through the list of network hospitals and make sure the one closest to your area of residence is also on the list. When your nearest hospital or clinic is on the empanelled list, it comes in handy during an emergency as you can get treatment without wasting precious time on the go.

Also, make sure to know the claims settlement process with your insurer for a non-network hospital. At the same time, inform your insurer immediately, whether you get admitted to a network hospital or a non-network hospital. Explain the process to your family members so that they can get the job done in case you are not available.

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