Difference Between Network and Non-Network Hospitals in Health Insurance

Talking about Network and Non-Network Hospitals in Health Insurance industries. The difference is so huge that it can cost you in lakhs. The amount you spent will be reimbursed later but in the present situation, you have to spend that amount on hospital expenses.

What is Reimbursement in Health Insurance?

Reimbursement in a simple term means getting your money back from the health insurance company. The amount that is spent on hospital expenses, ambulance, pre-hospitalization and post-hospitalization and any other expenses. All the amount of such things is initially paid by you but later your health insurance company will repay it back.

Coming to our topic about the difference between Network and Non-Network hospitals. Network hospitals are the hospital which has a tie-up with your health insurance company and non-network hospitals are those who don’t have to tie up with your health insurance company.

Network Hospitals


The term network hospitals in health insurance signify the hospital that has a tie-up with your health insurance company. You can avail the cashless facility there. When you go to a hospital for an operation or in an emergency, you just have to show your health policy I-Card. By showing the I-Card you have to pay nothing to the hospital. All your hospital financial expenses will be covered by your Mediclaim Company.

You have to intimate your health insurance company and you have to be in contact with the hospital TPA department as they will send an approval request to your health insurance company. After the approval, your cashless treatment will proceed. In this case, you have to get in touch with health insurance financial advisor. Some hospitals can ask for some security deposit, but that is returned later on.

Example: Manoj visited a network hospital for an operation. It was a planned operation. The doctor already informed him about the operation. Few medicines were given by the doctor and some tests were done before an operation. The amount of OPD and test was given by Manoj. But he keeps a record of all the expenses of Pre Hospitalisation so that after discharge he can request the company to reimburse his Pre Hospitalisation Expenses. Before getting admitted in the hospital Manoj told about his operation to his health insurance company.

The company told him some preferred hospital near his home. Luckily the hospital he was planning was a preferred hospital. So, because of the preferred hospital, he got a reward of Rs. 5000 from his health insurance company. When he visited the hospital he gave them his health Policy I Card and within a few minutes, he got approval. Without spending penny; already earned Rs. 5000 and was admitted without spending any amount. He took a single AC room and enjoyed the comfort which is a beneficial thing when you are a patient. He was in a hospital for 10 days. After discharge, he came back home and as doctor prescribe he was taking medicines for 2.5 months. After completing his medicine course then send all the expenses record, bills and other to his company. Within a few days, the company transferred all the amount in his bank. In such a way he got strong financial support, reward and peace of mind by visiting a preferred network hospital. His expenses were reimbursed.

This was an example of Network hospital. You should know in advance the network hospitals available in your area.

Non-Network Hospitals


The term Non-Network hospitals are the hospitals where you cannot use the cashless facility. You can reimburse the amount that you spend on the hospital expense but while hospitalization you have to give that amount from your pocket for hospital expenses.

Example: Manish visited the doctor for some health issues. The doctor told him to get admitted in the hospital after 5 days for an operation. He was feeling very relaxed from the financial side because he already has purchased a health policy. He visited the hospital and gave them the I Card. After that the TPA department of the hospital that we do not network hospital of your health insurance company. We can’t provide you cashless facility. After listing to this, Manish got very angry and called his health insurance agent.

He told him that you are my financial consultant and you sold me health policy of a bad company. His Health Insurance Financial advisor told him, that you should have discussed with me or with the company about your operation. Nor you have checked it online about the list of network hospitals. You will get reimbursement but right now you have to pay.

Now it was a difficult situation for Manish. His family members started arranging funds and borrowing from others. Along with the health issues now Manish and his family have to face financial issues also. Later Manish arranges all the documents and bill for reimbursement and gets all the amount back in his bank account. To avoid such a situation you should be aware of the network hospitals near you.

Conclusion


In the case of pre-planned operation, you have time to find cashless hospitals near you but in case of an accident, you don’t have time to find cashless hospitals. You should be aware of the network hospitals available near your home and office. You can get the list of cashless hospitals near you from the website. Your family members should also be aware of the cashless hospitals nearby.

Related Blogs to boost your knowledge

Leave a Reply

Your email address will not be published.