Network and Non-Network Hospitals: What is the Difference?

Cashless mediclaim and list of network hospitals are two of the most important criterions that people consider while buying a health insurance. The longer the list of network hospitals for an insurance company, the more convenient it is to find one in the vicinity. 

However, have you ever considered what the difference between network and non-network hospitals is?

Network Hospitals

Every insurance company appoints a network of hospitals, clinics and medical professionals who charge a lower fee for their policyholders. And in return hospitals get more patients who are channelled to them through the insurance company’s network.

Health insurance companies understand that in case of illness, the insured person will return back to them with huge claims, which means they will have to make substantial payouts. To turn the situation in their favour, they negotiate with the hospitals and make them a part of their network. 

Network hospitals charge a lower fee from a customer with medical insurance cashless plan as compared to those without one. They, in turn, benefit from a large number of policyholders coming to their hospital to seek treatment.

Network Hospitalization versus Non-Network Hospitalization

In the case of network hospitalization, the patient gets admitted or seeks treatment in one of the cashelss insurance hospitals in the insurance company network. The patient can then submit the form to TPA for cashless mediclaim. Once the cashless claim is approved, the patient can seek the treatment and all the expenses will be directly borne by the insurance company. The patient won’t have to submit any bills or documents and there is no waiting period. The only expenses the policyholder will bear are those which are not covered under the policy.

However, when a person is admitted to a non-network hospital, he has to pay for the whole treatment. After discharge, he can submit all the documentation and required report to the insurer. The insurer will check all the documents and approve whatever it finds reasonable. The amount is then refunded to the patient after 10-12 days.

It is important to note that someone who has not opted for health insurance with cashless facility will have to go through the entire process of submitting bills and documentation even if he is admitted in a network hospital.

The Bottom line

If you have a cashless mediclaim policy, it clearly makes sense to get treatment in a network hospital. Always, have a list of best health insurance cashless network hospitals ready in case you have to go for sudden hospitalization. Opt for non-network hospitalization only in case of emergencies or when the required treatment is not available in any of the network hospitals. As a policyholder, you want the best treatment in the smoothest way possible and getting treatment from an HDFC ERGO network hospital provides you exactly with that.

Disclaimer: The above information is for illustrative purpose only. For more details, please refer to policy wordings and prospectus before going ahead with the sales.

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