The Role of Network Hospitals in Health Insurance: A Complete Guide
Network hospitals in health insurance are medical facilities that directly have an agreement with a health insurance provider, permitting cashless treatment and direct billing between the hospital and the insurance company. In general, the network hospitals in health insurance provide a convenient and financially effective experience for health insurance policyholders, with features like cashless treatment options and smooth claims processes. Meanwhile, non-network hospitals might need upfront payments and a complex reimbursement process. Network hospitals have claim processes, lowering administrative troubles and enhancing faster processing by the health insurance company.
The insurance company directly settles the bills, reducing paperwork and time spent on insurance claims. Non-network hospitals need patients to submit bills and documentation for the reimbursement process, which could be a lengthy process. Meanwhile, non-network hospitals provide flexibility in terms of location and choice. But, network hospitals offer a convenient, cost-effective, and hassle-free experience, especially for those with health insurance. Network health hospitals offer many advantages, such as cashless treatment. With the cashless treatment option, policyholders can get treatment without making out-of-pocket payments. The insurance company manages the financial transactions directly with the network hospital. Network hospitals have agreements with insurance companies that permit cashless treatment and simpler claims, while non-network hospitals do not have such agreements and need upfront payments and reimbursement. Many customers have benefitted from the Network hospitals of Star Health Insurance. There are 16000+ star health insurance network hospitals.
Network Hospitals Explained: Benefits and Importance in Health Insurance
Hospitalisation may cost a huge amount, so most people opt for health insurance to protect themselves financially during critical times. Many policyholders are not aware of a benefit called cashless treatment provided by the network hospitals of their health insurance companies. Here you will learn about the Network Hospitals and how they differ from the Non-Network Hospitals.
Network Hospitals
Network Hospitals are a set of hospitals that have an agreement with an Insurance company and provide cashless treatments to the policyholder. If the policyholder undergoes treatment at a network hospital, the insurance company will settle the bills directly with the hospital.
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It is challenging to find Network Hospitals when a medical emergency arises. To avoid such challenges, a policyholder must know the network hospitals that they can easily access while opting for a health insurance plan.
Insurance companies concord with the Network Hospitals, so the policyholder can claim a cashless treatment. The Insurance company settles the treatment costs and medical expenses of the insured.
Example
Ms Aralya was hospitalised for a specific surgery at a network hospital. Her treatment cost is Rs. 2,00,000/-. When she claimed a cashless treatment for that surgery, the Insurance company dealt with the hospital in paying the medical bills.
Types of Network Hospitals: A Broader Classification
Apart from network and non-network hospitals, there are different types of hospitals you should know about.
- Public hospitals: These are run by the government and usually offer affordable treatment.
- Private hospitals: These hospitals have modern facilities and provide a wide range of services.
- Speciality centres: These focus on specific treatments like heart care, cancer, or bone and joint problems.
- Clinics: These are mainly for doctor consultations and basic treatments.
- Diagnostic centres: These places do lab tests and scans to help with diagnosis.
With all these options, insurance companies can include different types of hospitals in their network, so you get the right care for your needs and budget.
How do you make a cashless claim at a Network Hospital?
The procedure for cashless claims at a Network Hospital may vary based on the policyholder’s hospitalisation.
If the policyholder chose a scheduled hospitalisation in a Network Hospital, the policyholder must notify their Insurance Company about the treatment. So they can avail the cashless treatment.
Suppose the policyholder is hospitalised for a medical emergency in a Network Hospital. In that case, either the policyholder or their family member must notify the Insurance company about their hospitalisation within 24 hours of hospitalisation.
To avail of the cashless treatment in the Network Hospital, the policyholder must show their Health Insurance ID card to the hospital management. Once the Insurance company pays the bills, it sends a bill settlement summary to the policyholder and the payments excluded by the Insurance company based on the policy documents.
Non-Network Hospitals
Non-network hospitals are hospitals that do not have an agreement with the Insurance company. If the policyholder is hospitalised in a Non-Network Hospital, they cannot claim a cashless treatment, and the Insurance company cannot deal with the bill settlements directly. In that case, the insured must pay the bills out of their pockets, and then they can claim a reimbursement. It is mandatory to know the details of the terms and conditions of the policy before opting for a Health Insurance policy as they may help during the needful time.
Documentation processes in Non-Network Hospitals are different from Network Hospitals. For reimbursement, the policyholder must keep all documents, like bills, receipts, etc. If any the document is found false, the claim for reimbursement will be rejected by the Insurance company.
Difference between Network Hospital and Non-Network Hospital
| Network Hospitals | Non-Network Hospitals |
| The policyholder can avail the cashless treatment. | The policyholder can avail the reimbursement. |
| Cash arrangements are not necessary in most cases. | Cash arrangements are necessary when hospitalised in a Non-Network Hospitals. |
| The Insurance company will pay the hospital bills, and the policyholder’s involvement is not required. | The policyholder must pay the bills, and then they can avail a reimbursement from the Insurance company. |
Conclusion
During a medical emergency, a person may forget the Network Hospitals and the cashless facility, etc. and may end up paying the bills on their own and will wait for the reimbursement from the Insurance company.
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To avoid such circumstances, go through the list of Network Hospitals on the Insurance company’s official website and check whether your nearby hospital and your family doctor are coming under the list.
Protect yourself from huge medical bills by purchasing a suitable Health Insurance policy for you and your family. Refer to the official website of Star Health for more information about health insurance policies.
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Non-network hospitals are not part of an agreement with the insurer and may not provide cashless facilities to the policyholders. Instead, one can get reimbursement after submitting the essential documents to the insurer.
You can check the list of network hospitals in health insurance by navigating to your health insurance provider's official website or by contacting them directly through phone or email.
Network Hospital: A hospital that has a tie-up with the insurance company to offer cashless treatment to the insured.
Policy Term: The duration for which the policyholder is covered under the health insurance plan. It differs from one year to multiple years, depending on the terms and conditions.
A wider network of hospitals reduces out-of-pocket expenses and makes cashless hospitalisation easier. It also simplifies the claim process since the insurer directly settles bills with the hospital.
A network hospital is one that has an arrangement with STAR Health to offer cashless services.
A network hospital is an empanelled hospital where you can avail cashless treatment, making hospital admissions and billing simpler and faster.
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