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

Health insurance companies are well aware that private medical set-ups tend to charge more from patients with health insurance cover rather than those without it. This naturally translates to losses for insurance providers. In order to ensure profitability and avoid incurring unnecessary losses, health insurance providers tie up with certain hospitals, making them a part of their ‘network’.

Read More

Get ₹5 Lac Health Insurance starts @ ₹200/month*
Get ₹5 Lac Health Insurance starts @ ₹200/month*
Tax Benefitup to Rs.75,000
Save up to 12.5%* on 2 Year Payment Plans
7 Lakh+ Happy Customers

*All savings are provided by the insurer as per the IRDAI approved insurance plan. Standard T&C Apply
*Tax benefit is subject to changes in tax laws. Standard T&C Apply

Get insured from the comfort of your home No medicals required
I am a

My name is

My number is

By clicking on ‘View Plans’ you, agreed to our Privacy Policy and Terms of use
Close
Back
I am a

My name is

My number is

Select Age

City Living in

    Popular Cities

    Do you have an existing illness or medical history?

    This helps us find plans that cover your condition and avoid claim rejection

    Get updates on WhatsApp

    What is your existing illness?

    Select all that apply

    When did you recover from Covid-19?

    Some plans are available only after a certain time

    Taking into consideration which hospital maximum number of policyholders go to in specific areas, insurance companies negotiate treatment and stay costs with these select network hospitals to prevent their expenses from spiraling.

    These chosen network hospitals become a part of the broad hospital network that specific insurance companies are associated with. All other hospitals outside this mutual network are referred to as non-network hospitals.

     

    A Closer Look to Understand between Difference between Network hospital and a Non-network Hospital

    The following examples will offer a better understanding of the major difference between getting admitted in a network hospital and a non-network hospital, and how it can impact health insurance claims:

    ‘A’holds a health insurance policy without the cashless benefit. Upon facing a health issue, he gets admitted into a network hospital. Here, ‘A’ gets full medical treatment as per his needs, however, the bills at that moment will have to be borne by him, out-of-pocket. Following discharge from the hospital, ‘A’ will need to submit his insurance claim to the insurance company with all the required original documents. The insurance company will check all documents, process the application, and give a final approval on the submitted claim in accordance with the policy terms and conditions.

    Get More: Find Network Hospitals in Your Area

    ‘B’ is covered with cashless insurance under the health insurance policy he holds.He is diagnosed with an illness, and decides to get admitted into a network hospital. Since ‘B’ has the cashless benefit, his family members get in touch with the third party administrator (TPA) to help him avail the cashless hospitalisation benefit. ‘B’ therefore gets excellent medical treatment without having to spend a penny from his own pocket. Following discharge, ‘B’ takes all the required claim-related documents to keep as records. In this case, ‘B’ will only need to bear those expenses that the policy explicitly states as not being covered.

    ‘C’ has a health insurance policy and on being diagnosed with an illness, he gets admitted in to a non-network hospital. In such a situation, it does not matter whether ‘C’ does or does not have a cashless medical cover – either way, he will not get this benefit from the insurance company, since he chose a non-network hospital.

    ‘C’ avails of the requisite medical treatment and bears the entire medical expenditure out-of-pocket. Following his discharge, ‘C’ files a claim for reimbursement with his insurance company with all the original supporting documents. The insurance company takes a microscopic look into each cost and only approves the amounts found reasonable and justified enough to be approved under the terms of the policy. The insurance company may approve either the full claim or only a part of it.

    The stated reasons are mostly on the lines of the specific amounts not being justified or covered – for instance, the health insurance company may say that some of the hospital charges are relatively higher in comparison with the regular market norms and hence they will refuse to reimburse it.
    ‘C’ therefore will not be able to leverage the complete benefits of his health insurance policy, in spite of having an adequate cover. He will, therefore, need to personally bear the cost of all those expenses that are outside the purview of his health insurance policy.

    Who Wins?

    As is clear in the above situations, getting medical treatment in a network hospital is always better and wiser.

    Every health insurance policy clearly mentions the complete list of all the network hospitals they are associated with. It is a good idea to have the network hospitals list always handy for quick reference during emergencies. This turns out to be a blessing in the event of sudden hospitalisation, as the policyholder can immediately approach any of the network hospitals and capitalise upon the health insurance plan - either by getting medical treatment at reasonable costs or by availing the cashless hospitalisation benefit. In case of pre-planned hospitalisation, the policyholder must contact the TPA and get all the necessary approvals beforehand.

    A Non-Network Hospital must be an Option Only in case of Unavoidable Emergencies.

    Policyholders pay premiums regularly and expect their health insurance policy to come to their aid in times of need. A part of this expectation is getting the best treatment without having to bear any additional expenses – opting for a network hospital provides just that.

    Written By: PolicyBazaar - Updated: 30 June 2021
    Search
    Disclaimer: Policybazaar does not endorse, rate or recommend any particular insurer or insurance product offered by an insurer.

    Health insurance articles

    Recent Articles
    Popular Articles
    Most-Important Lessons from the Covid-19 Pandemic

    23 Sep 2021

    Not very long back, the entire world was thrown aback by a...
    Does Health Insurance Cover Preventive Health Check-ups?

    22 Sep 2021

    Every object needs to be checked regularly to identify a...
    Bid Goodbye to Seasonal Diseases during the Pandemic with 7 Basic Practices

    21 Sep 2021

    Adding to the insurmountable loss of life the ongoing COVID-19...
    What is the Survival Period in Health Insurance?

    21 Sep 2021

    The prevalence of critical diseases in India has increased...
    Health Insurance for Autoimmune Diseases in India

    16 Sep 2021

    Every human body comes with an immune system to fight against...
    Best Health Insurance Plans in India 2021
    Finding the best health insurance plan from so many different health insurance companies can get confusing for many...
    Top Maternity Insurance Plans
    Maternity or pregnancy is an important phase of life, and one needs to prepare in advance to embrace parenthood...
    Top Family Health Insurance Policies in India 2021
    From the air we breathe to the food we eat; everything is intentionally or unintentionally subjected to...
    Health Insurance Claims Ratio- Things You Should Look Before Buying Health Insurance
    There has always been a doubt in customers mind about whether the private company will keep its side of the bargain...
    Best Health Insurance Plans for Senior Citizens in 2021
    Considering the increasing percentage of medical inflation in India, it has become an absolute necessity to buy...
    Close
    Download the Policybazaar app
    to manage all your insurance needs.
    INSTALL