Network Hospital In Health Insurance Refers To What! - Loop

A network hospital in health insurance refers to the hospital that has made a cashless treatment agreement with an insurer. Read more to know about claim processing in network and non-network hospitals.
Team Loop Health
June 10, 2021

For health insurance policyholders, the most important aspect is to get timely medical aid with a smooth claims process. Therefore, terms such as ‘cashless claims’ and ‘network hospitals’ are crucial factors while purchasing the insurance cover or zeroing down on the policy provider. A network hospital in health insurance refers to the hospital that has made a cashless treatment agreement with the health insurance company.

It’s a proven fact that availing cashless benefits of health insurance is always better. It allows you to walk easily into a network hospital and get medical treatment without shelling out a single penny from your pocket. But, what happens in case you are not eligible for a cashless health insurance claim, or you need to visit a non-network hospital because of an emergency?

Let’s find out by analyzing the differences in formalities and the process to file a claim between network and non-network hospitals below.

What Are Network Hospitals?

Network hospitals are the ones stated in the agreement you have with the insurance provider. These are also known as cashless network hospitals.

What Is Non-network Hospital?

Non-network hospitals means hospitals that are covered in the said agreement you have with the insurance provider.

Difference Between Network And Non-network Hospitals:

More often than not, well-known hospitals are listed under the network of most insurance providers. This makes it not only time-saving but also more secure to get medical treatment at a network hospital in case of emergencies. But, this does not in any way discount the credibility of non-network hospitals.

Claim Processing, Formalities, And Waiting Time In Network Hospitals:

Generally speaking, the claim process is faster, smoother, and hassle-free at network hospitals. This is because policyholders need not go through the ordeal of collecting and submitting documents for reimbursement. The patient can simply walk into a network hospital, submit a pre-authorization form at the insurance desk of the hospital.

The employee at the desk will check for accuracy before sending the form to the Third-Party Administrator (TPA). According to the terms and conditions of the health insurance policy, the Third-Party Administrator will process the form and either approve or deny the claim request. If the form is accepted, the Third-Party Administrator will send an authorization letter detailing the treatment amount approved. This is a completely cashless Mediclaim process with no waiting time and timely treatment.

However, since a non-network hospital is not registered with the insurance provider, it requires the policyholder to pay for the whole treatment upfront, gathers documents, proof, and medical bills of the treatment, and submit them to the policy provider for reimbursement. This increases the waiting period for claim processing, requires the policyholder to dispense urgent cash, and goes through the arduous process of gathering documents and submitting them as proof.

While cashless claims at network hospitals are approved almost instantaneously, the reimbursement process for treatment at non-network hospitals takes 10-15 days as there is a waiting period for verification before which one can receive the claim amount.

In the case of non-network hospitals, there is also a higher chance of medical expenses not being approved beyond a certain threshold as the insurance provider may not find them justified as per market standards. Simply put, the scrutiny is always higher for hospitalization claims at non-network hospitals, thereby jeopardizing the policyholder’s overall position.

When To Visit A Non-Network Hospital?

In the case of both cashless as well as non-cashless claims, it is undoubtedly better to visit a network hospital for treatment. Without the cashless benefit, the policyholder will still be required to collate proof for reimbursement and pay cash upfront for treatment. But even then, the claim processing can be smoother and less time-consuming.

In case of unavoidable health emergencies, it is better to visit the nearest hospital facility, even if the same is not registered with the insurance provider. It would be unwise to travel all the way up to the network hospital in such cases, as even a few minutes could make a big difference amid a healthy contingency.

Health Is Wealth:

Cashless health insurance claim at a network hospital comes with its own benefits. It allows policyholders to capitalize on their health insurance plan and make the most of it.

Even without the cashless benefit, it’s advisable to visit a network hospital for the faster reimbursement claim processing. It’s also best to keep the list of network hospitals in handy for quick reference. However, in case of unavoidable health emergencies, you can rely on non-network hospitals.

After all, you can’t control the wind, but you can adjust the sails.

Interested in learning more about Claims in Group Health Insurance? Click here

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