Healthcare is a significant aspect of our lives, and health insurance policies have emerged as crucial tools to combat rising medical costs. One critical aspect to understand while choosing a health insurance plan is the distinction between network hospitals and non-network hospitals. This article provides a comprehensive guide to help you understand these terms and the implications of availing medical treatment from either type of hospital.
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Decoding Network hospitals and Non-Network Hospitals
In the realm of health insurance, the hospitals associated with health insurance companies are termed as network hospitals. These hospitals form a part of the insurer’s network due to partnerships formed to negotiate costs and provide a seamless claims experience to the insured parties. The faster claim settlement and improved customer satisfaction make this arrangement beneficial for both the insured and the insurer.
On the contrary, hospitals that are not associated with health insurance companies are referred to as non-network hospitals. In these hospitals, even though you can still avail medical treatments, the process of claims might differ significantly from that of network hospitals.
The Working Mechanism of Network and Non-Network Hospitals
The distinction between network and non-network hospitals becomes more apparent when you understand how the process of availing treatments and settling claims works in these facilities.
Network Hospitals with Cashless Facility
In the case of network hospitals, the insured individual can avail a cashless facility, where the insurance company settles the hospitalization expenses directly with the hospital. The policyholder only needs to pay the deductible amount as per the policy terms. This facility drastically reduces the hassle for the policyholder, who does not have to arrange funds for treatment or wait for a claim reimbursement.
Network Hospitals without Cashless Facility
There might be cases where the insured gets admitted to a network hospital but hasn’t availed the cashless facility. Here, the policyholder must pay the treatment costs upfront and then claim a reimbursement from the insurance company. The claim settlement process might be longer and require the policyholder to collate all relevant bills and documents for submission to the insurance provider.
Non-Network Hospitals
In non-network hospitals, regardless of whether the insured has availed the cashless facility, the process resembles the scenario of network hospitals without cashless facility. The insured individual must bear the treatment costs, get discharged, and then claim reimbursement. The process is often long, requires arranging the funds upfront, and might take longer for claim settlement.
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A Comparative Analysis: Network vs Non-Network Hospitals
To give you a clearer picture, here’s a side-by-side comparison of the characteristics of network and non-network hospitals.
| Parameter | Network Hospital (Cashless Facility) | Network Hospital (Without Cashless Facility) | Non-Network Hospital |
| Definition | The insured is admitted to a partner hospital and has availed of the cashless benefit. | The insured is admitted to a partner hospital but has not availed of the cashless benefit. | The insured is admitted to a non-partner hospital. |
| Working Mechanism | The insurer settles hospitalization expenses directly with the hospital. The insured pays the deductible as per policy terms. | The insured pays all expenses and then claims reimbursement. | The insured pays all expenses and then claims reimbursement. |
| Waiting Period | No waiting period. Once approved, the insurer settles the bill immediately. | Yes, there is generally a waiting period of 10-12 days (varies with the insurer) between raising and receiving the claim amount. | Yes, there is generally a waiting period of 10-12 days (varies with the insurer) between raising and receiving the claim amount. |
| Features | Quick settlement, No need for the insured to arrange funds, Hassle-free experience. | Settlement takes time, The insured needs to arrange funds, The process can be long and tedious. | Same as a network hospital without cashless facility. |
| Treatment Options | May have a wider range of treatment options due to partnerships with insurance providers. | The same as network hospitals with cashless facility. | The treatment options depend solely on the hospital, which may be more limited or more extensive. |
| Geographic Coverage | Limited to the hospitals within the insurer’s network. | Same as network hospitals with cashless facility. | Can be any hospital, regardless of location. |
| Emergency Treatment | Emergency treatments are usually covered without any issues due to the existing agreement with the insurance company. | The insured may have to pay for emergency treatments and then apply for reimbursement. | Same as a network hospital without cashless facility. |
In light of this comparison, it’s evident that availing medical treatment from a network hospital with a cashless facility offers the most convenience. However, it’s essential to note that your choice of hospital, network or non-network, might also depend on factors like the specific treatment you need, the hospital’s proximity, and availability in case of an emergency.
Health Insurance with Healthysure
Choosing the right health insurance policy for yourself or your employees can be a daunting task. Healthysure is a platform that simplifies this process by offering comprehensive health coverage that can be custom-designed according to your needs. Healthysure partners with the best insurance providers to ensure that you get the plan that fits you best.
Healthysure’s group health insurance offers coverage for pre-existing diseases from day one and includes coverage for the insured’s spouse, children, and parents. It provides access to cashless claims through network hospitals, with no capping on room rent allowance, and covers pre and post-hospitalization bills.
Moreover, Healthysure also offers a variety of health and mental wellness programs to engage your employees and take care of their overall wellbeing. These tailor-made sessions are suitable for both in-house and remote teams. If your team members cannot attend the sessions at the scheduled time, they can access the video recordings at their convenience.
Conclusion
Understanding the distinction between network and non-network hospitals is crucial for anyone with a health insurance policy. This knowledge can significantly impact your out-of-pocket costs, the quality of care you receive, and your overall experience when dealing with medical issues.
It’s also important to understand the concept of cashless facilities offered by insurance companies. A network hospital with a cashless facility can provide a hassle-free, immediate treatment experience, removing the burden of arranging funds during a health crisis.
However, remember that the best choice depends on individual circumstances, including the specific medical need, the location and reputation of the hospital, and the terms of your insurance policy. Armed with this knowledge, you can make informed decisions that can potentially save you time, money, and stress.
FAQs
What is a network hospital?
A network hospital is a hospital that has an agreement with a health insurance company to provide services to its policyholders at lower costs. These hospitals are part of the insurance company’s “network”.
What is a non-network hospital?
A non-network hospital, also referred to as an out-of-network hospital, does not have a contract with the health insurance company. Therefore, you may face higher costs if you choose to get care from a non-network hospital.
What does a cashless facility mean?
A cashless facility is a service provided by the insurance company where the costs of treatments are directly settled between the insurer and the hospital. This means that the policyholder doesn’t have to pay upfront and then seek reimbursement.
Can I get treatment at a non-network hospital?
Yes, you can get treatment at a non-network hospital. However, the reimbursement process may be more complex and the costs may be higher compared to a network hospital.
