Difference between Network and Non-Network Hospitals?

Network hospitals are those hospitals that are tied up with the insurance company to offer cashless claim settlement facilities to their customers.

Customers who use their hospitalization benefits in any of the network hospitals can choose a cashless option, in which the insurance company pays the claim bill directly to the hospital, eliminating the need for the customer to pay first and then claim from the insurance company. 

What is the meaning of Network Hospitals?

The network hospitals have a dedicated insurance desk to help customers with their health cards, whether group health insurance or retail health insurance. Insurance companies have a predetermined package for every treatment offered by the hospital, which makes life easy for both the insured and the insurance company. 

What is the meaning of non-network hospitals?

Non-network hospitals are those that are not tied up with the insurance company and cannot offer cashless claim settlement services to the customers of the insurance company.

The claim settlement in the case of non-network hospitals would be on a reimbursement basis where the insured has to settle the hospital bill at first and then submit all the hospital bills and other necessary documents to the insurance company within the stipulated period to avail of the reimbursement. 

What is the primary difference between network and non-network hospitals?

The cashless claim settlement option is not available in non-network hospitals. The insurance company does not have a formal relationship with these hospitals. 

How to Search Network Hospitals List?

The network hospital list can be found on the website of the insurance company. It is important to note that the network hospital list is dynamic and is subject to change as there would be new hospitals getting added to the list and old hospitals getting deleted from the list from time to time.

The more hospitals in the network, the better, as the insured would have more options to choose from. 

Advantages of Network hospitals:

Cashless facility:

1. The biggest advantage of the network hospitals is the cashless claim settlement facility offered by them.
2. The insured need not run for funds at the time of hospitalization from pillar to post as the claim settlement would be on a cashless basis.
   
3. The insurance company would directly settle the claim with the treating hospital. 
   
4. All the customer has to do is fill out the pre-authorization form and submit it to the hospital, which will process the claim settlement facility. The policyholder need not pay anything except for nominal charges at the time of hospitalization in the case of the network hospitals. 
   
5. The maximum liability of the insurance company in case of the cashless facility at the network hospitals would not exceed the sum insured limit mentioned in the policy. 
   
6. The claim can be filed as planned hospitalization or unplanned hospitalization. Planned hospitalization is when the insured is aware of the date and time of treatment and also the hospital in which he would be treated. 
   
7. In case of planned hospitalization the insured needs to give a communication to the insurance company at least 48 hours prior to the admission which would facilitate the insurance company to process the claim.
   
8. Unplanned hospitalization is when the insured is not aware of the date and time of hospitalization. 
   
9. Hospitalization occurs due to unforeseen circumstances, such as accidents or illnesses.
   
10. In case of unplanned hospitalization, the insured can report the hospitalization to the insurance company within 24-48 hours of admission so that the cashless claim settlement can be processed if the claim is availed in any of the network hospitals.
    
11. In the case of a cashless claim facility, the pre-authorization would be given by the insurance company within the shortest possible time. A few companies mention that they would give pre-authorization within 2 hours of admission to the hospital.
    
12. This is known as the turnaround time which varies from one insurance company to another but almost all the insurance companies would try to maintain a TAT of a few hours. 

Peace of mind: 

1. The other major advantage of the network hospital is that the customers can get peace of mind. Insured need not worry about arranging the funds and can avail the treatment without any worry.
   
2. The family members of the insured customer can also be at peace as they would not have to rush from one person to another to arrange the funds in case of hospitalization.
   
3. The hassle of arranging funds for planned or unplanned hospitalization would not be there in case of the network hospitals.