What is the Difference Between a Network and a Non-Network Hospital?

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While purchasing a health insurance plan, it is essential to differentiate between network and non-network plans.


To be specific about its differences, network hospitals have direct tie-ups with insurance providers, while non-network hospitals lack this partnership. This can often result in certain limitations for the policyholders.


What are the Key Differences Between Network and Non-Network Hospital?




































Feature



Network Hospital



Non-Network Hospital



Claim Process



The claim process with network hospitals is handled directly by the insurance provider and the hospital.



If the policyholder seeks treatment at a non-network hospital, they have to raise a claim after recovering.



Billing Process



You will get cashless facilities here.



You have to make an upfront payment here and later get reimbursement for it.



Documentation and Formalities



Policyholders mostly have to share their basic personal and insurance details.



A lot more complicated than a network hospital. Here, you need to submit a copy of every receipt, report, and discharge summary, along with a duly filled-out claim settlement form.



Claim Processing Time



Not required to wait for a claim as the insurer settles it with the network hospital.



Processing time can vary across providers. Most providers settle your claims 10−12 days after receiving the request.



Hospital Selection



The policyholder will get a limited option, often selected by the insurer.



The list is unlimited. However, it will increase your out-of-pocket expenses.



How do Network and Non-Network Hospitals Work?


Let’s understand how network and non-network hospitals work with the following example:



  • For Network Hospital


Mr. Ghosh needs to undergo a knee replacement surgery. Therefore, he chooses a network hospital from his insurer’s list.


Once he gets hospitalised, his family provides his insurance card at the TPA desk of the hospital. After his insurer approves the pre-authorisation, he will receive the treatment without paying the hospital bill out of pocket.



  • For Non-Network Hospital


If Mr. Ghosh conducted the knee replacement surgery at a non-network hospital, his family would have to make the upfront payment of the hospital bill. In this case, to get the claim amount, they would submit the necessary paperwork to the insurer for reimbursement.


When to Seek Treatment in a Non-Network Hospital?



  • During an emergency, you should go to the nearest hospital, even if it's a non-network hospital.



  • In case your network hospital is too far away from your location, you should consider going to a non-network hospital.



  • Seeking treatment at a non-network hospital becomes necessary when your nearby network hospitals lack adequate resources.



  • If a policyholder faces a medical emergency while serving a waiting period (generally 30 days initially), there is no other option than to visit a non-network hospital, as claims cannot be raised during this time.


Final Words


If you do not want to face the hassle of arranging immediate funds during sudden hospitalisation, choose an insurance provider with a wide network of hospitals.


In fact, apart from its number, you must also verify the location and facilities provided under these hospitals to ensure seamless treatment.