Non-Network Vs Network Hospital
- Understanding the difference
- Which one is better?
- How does it work in both?
Rahul felt a sudden pain in his stomach and fell unconscious. His family rushed him to the nearby hospital. They told him that he needed to stay in the hospital for a few days as he had some infection in his stomach. Now the doctor's asked to settle the bill. But at the bill counter, they learned that the hospital is not in the network of Rahul's health insurance policy. However, they are still eligible for cashless settlement. Thanks to the "Cashless Everywhere" initiative by the General Insurance Council and IRDAI, Rahul was admitted to the hospital in emergency circumstances, and he is eligible for cashless claims to the non-network hospital as well.
While choosing a health insurance policy, we always look forward to the number of network hospitals the company is offering. But, the company also provide coverage for non-network hospitals, where you need to apply for reimbursement. So, yes in the insurance world, there is a huge difference between network hospitals and non-network. Let us understand further in detail below:
| Basis | Network Hospital | Non-Network Hospital |
|---|---|---|
| Definition | Hospitals that are in connection with the health insurance company are called network hospitals. | Hospitals that are not present in the list of hospitals by health insurers are known as non-network hospitals. |
| Contract Agreement | Network hospitals have a formal agreement with the insurance providers. | Non-network hospitals do not have a formal agreement or contract with the insurance provider. |
| Benefits | You will receive the services at reduced or pre-negotiated rates. | You might face higher out-of-pocket costs for the services you receive. |
| Billing Process | Most of the time, your health insurer will directly settle the bills with the hospital. | Most of the time, you need to pay the bill upfront and seek reimbursement from your insurer later. |
| Listing | Network hospitals are usually listed in the provider's directory of the insurance plan. | Non-network hospitals are not listed in the directory of the insurance provider. |
| Insurance Coverage | You will get comprehensive coverage for the rendered services. | Your coverage may be limited or may be subject to different reimbursement rates. |
| Waiting Period | No waiting period applied. Your bill will be settled immediately. | Yes, there will be approximately 10-15 days of waiting period applied for reimbursement. |
| How does it work? | With the network hospital, you need to file the claim and the insurance company will settle the bill directly with the hospital. | For emergencies, your bill will be settled directly, but in case of planned hospitalisation, you need to pay the bill from your pocket and then apply for reimbursement. Then the company will reimburse the lump sum amount that you paid against the hospitalisation. |
Choosing between network and non-network hospitals is entirely your decision. You need to understand a few things before choosing the right hospital. Have a look below:
If you understand the key difference between network hospitals and non-network hospitals, then it will be easy for you to choose the best for your medical requirements. Recent regulations that allow cashless claims in even non-network hospitals during emergencies are providing greater flexibility in accessing healthcare. All you need to do is stay informed.
In case of any query, you can reach out to us.
Hospitals associated with health insurance companies are known as network hospitals and hospitals that are not associated with health insurers are called non-network hospitals.
It refers to the group of hospitals and healthcare providers that are mentioned in the health insurance policy. You can avail of cashless benefits from these hospitals.
In case of availing of treatment from non-network hospitals or healthcare providers that are not in contract with your health insurance company, you need to apply for a reimbursement claim or non-network claim.
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An explorer and a curious person, Simran has worked in the field of insurance for more than 3 years. Traveling and writing is her only passion and hobby. Her main agenda is to transform insurance information into a piece that is easy to understand and solves the reader’s query seamlessly.
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