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All you need to Know about Network Hospitals in India

Network hospitals are registered with the health insurance companies to make cashless treatment available for insured members who want to avail cashless treatment, as per the policy terms and conditions. Cashless hospitalization allows the policyholder/insured members to avail medical treatment without paying any amount at the time of hospital admission.

It is quite helpful in case of medical emergencies as it takes the financial burden off an individual’s shoulders. It is important to consider all these factors at the time of policy purchase, including the list of network hospitals that the insurance provider has to offer. You need to check the list of network hospitals and the number of hospitals that are there in your vicinity.

Cashless hospitalization allows insurance companies to save cost with discounted packages. The insured members do not need to pay anything from their own pocket.  Amid so many challenges in the Indian Insurance market as it is working towards to offer cashless international treatment as well.

What All Should You Take Into Consideration?

There are different parameters on which the medical insurance works, and is quite different from other insurance policies where the claim amount is mostly recompensed.

One of the common mistakes that most of the insurance buyers make is that they fail to go through the policy wordings and the list of network hospitals. So, here is a quick rundown of the factors that you need to take into consideration:

You can start by checking if any of your well-known doctors come in the network list. Commonly, people first consult with their family doctor in case of any medical emergency. And if your doctor is in such hospitals, you will be insured from day one.

Only checking network hospitals may not be sufficient. You also need to check the detail of the hospital in question.  Check for their services, the doctors on the panel, the ratings, what treatment and specialties they offer, if they provide 24-hour emergency service, and other facilities that may be required. It should be one of the crucial deciding factors when buying a cashless medical insurance policy.

Insurance companies broadly assess hospitals on the above-mentioned criterions, to ensure that they only get the most reputed and well-equipped hospitals added to their network list.

After you have purchased your health insurance policy, do not forget to collect your cashless card from the insurer. Also, remember to keep it handy, so that you have it ready in case of an emergency.

It is always beneficial to have a few network hospitals in your vicinity, though it is not one of the dominant factors when buying a cashless medical insurance policy, but important to check. Most crucial factors that should be considered important are coverage provided (including the services and the facilities that are offered), the limitations, etc.

Buy a medical insurance policy after taking into consideration all the factors so that you can buy a policy that fulfils your requirements, instead of adjusting onto a single factor.

Difference Between the Network and Non-Network Hospitals

Before you check if the network hospitals/hospital in your area meet your expectations or the essential criteria, it is important to know what is the major difference between a network or non-network hospital. Here is a quick rundown:

  • Network Hospitals: Health insurance providers usually have a tie-up with a number of hospitals across the country. Such hospitals fall under the Preferred Provider Network. As medical insurance companies have their separate TPA/Third Party Administrators at all of the network hospitals, for insured members to be able to easily avail cashless treatment and easily settle their hospitalization claims.
  • Non-network Hospitals: you can also take treatment in a non-network hospital. Though, you would need to pay the initial expenses. You can submit the bills to your health insurance company and claim for reimbursement of your hospital bills.

Filing Cashless Hospitalization Claims

Now you are aware as to how to identify a network hospital as per the policy wordings. Do you also know what is the difference between network and non-network hospitals? Therefore, the next logical step is to comprehend what all hospitalization expenses you can claim.

By merely visiting the hospital you do not become entitled to lodge a claim. To be eligible to get the compensation you need to get admitted to the hospital for more than 24 hours. However, there are insurance policies that cover day-care treatments like cataract surgery, varicose veins surgery, etc. you can check what all treatments are covered in the policy wordings.

Your health insurance policy will also compensate for pre and post hospitalization expenses. Generally, all the medical expenses related to the treatment that was incurred 30 days before the hospitalizations are also covered under this plan. Also, expenses incurred after 60 to 90 days of hospitalization can also be claimed after submitting the required forms and receipts.

Some plans also cover domiciliary treatments under hospitalization expenses. If the insured patient is not medically fit to be taken to a hospital or if there are insufficient hospital beds, then you can take treatment at home. You can also file a claim for such treatments.

In Short

It is clear that all medical insurance policies provide hospitalization benefits, you should be fully aware of all the benefits including network hospitals before finalizing a health insurance plan.

Written By: PolicyBazaar - Updated: 25 August 2020

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