Overview
Hospitalisation may cost a huge amount, so most people opt for Health Insurance to protect themselves financially during the critical time. Many policyholders are not aware of a benefit called cashless treatment provided by the Network Hospitals of their Health Insurance company. 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 to the Hospital.
It is challenging to find Network Hospitals when a medical emergency arises. To avoid such challenges, a policyholder must know the Network Hospitals which 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 in 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.
How to make a cashless claim at a Network Hospital?
The procedure for cashless claim 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 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 are not with 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 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.
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 Star Health official website for more information about Health Insurance policies.
