Quick Guide to Network Hospitals in the Healthcare Ecosystem

Understanding the role of network hospitals while deciding on your group health insurance provider
Team Loop Health
June 10, 2021

Growing healthcare expenses are always one of the top concerns during financial planning discussions. You hear stories about how you have to borrow loans at high interest rates to meet the high cost of treatment which can fill you with fear.

However, opting for health insurance on time can help you enjoy your present without worrying about your medical expenses in the future. Keeping this in mind, cashless claims are definitely the way to go. But before that, it’s important to be prepared with a crucial element while going cashless - network hospitals. Network hospitals are indeed a relief for high expenses treatments. Let’s see how.

What are Network Hospitals?

Network hospitals are entities that allow your care provider and insurance company to work in harmony and offer the finest of treatments without burning a hole through your pockets. Every insurance provider maintains a network of hospitals in their panel to offer cashless treatment to their policyholders.

When a policyholder buys a particular insurance, they have a list of hospitals handy to seek treatment where they can display their “cashless insurance card” to avail treatment. Therefore, a person or person’s family need not focus on the exorbitant expenses if a medical emergency arises. Once they show their cashless card registered with the insurance company, the network hospital will directly settle the claims with your insurer.

Hospitals that don’t fall under this category are known as non-network hospitals. You’ll read more about this shortly.

Benefits of a Network Hospital

One of the biggest benefits of a network hospital is that the majority of the expenses are borne by the insurer. And so, you don’t have to run around arranging finance for hospitalization or treatment at the nth moment. As insurers directly settle bills with the hospital, it lifts a huge burden off your shoulders.

The Anatomy and Working of a Network Hospital

If you’re seeking treatment, you may think a financial arrangement between your insurance provider and network hospital is a strategy to attract more patients. However, it's more than that as quality of care should never be compromised.

That's why insurance providers perform regular audits to ensure the highest quality of care and treatment. This can also include adding or deleting hospitals from their network.

The cost of care can go through the roof and insurance providers have the idea that serious illnesses and medical emergencies can attract hefty claims.

That's why they negotiate with healthcare providers and convince them to be a part of their network. The arrangement is a win-win for all because network hospitals charge less from the insurers while keeping the quality of care intact.

Understanding The Process Governing Network Hospitals

Before elaborating about the process for network hospitals, it’s essential you understand the concerns with non-network hospitalizations.

Non-Network Hospitalization: You will have to bear the expenses from your own pocket, followed by submitting a reimbursement claim. Then, your insurance provider will reimburse the money post verification and accounting for what’s not covered under the policy. That’s why opting for a network hospital is a better option as it saves you from financial distress.

Network Hospitalization: In the case of a medical emergency or treatment, a patient only has to pay for what’s not covered under the policy and the rest will be borne by the insurance provider which is “cashless treatment.” Your insurance documents will clearly outline the amount of coverage you are entitled for, what’s included, or what’s excluded in your insurance policy. So, make sure you understand the sum insured and other terms and conditions of the policy.

How Network Hospitals Work?

Planned Hospitalization: In a planned hospitalization model, the insured person is aware of the date of hospitalization and the treatment to undergo. The process is fairly smooth and the insured person can book a prior appointment with any of the network hospitals on their insurers’ list.

Standard Process for Planned Hospitalization:

  • Keep your cashless card ready and fill out the pre-authorization form
  • Submit your health insurance claim form at the hospital for physician and insurance provider’s verification
  • Wait for the approval from the Third Party Administrator (TPA) or Insurer
  • Submit the authorization letter and your insurance card on the day of admission

Emergency Hospitalization: In an emergency hospitalization model, a person either needs immediate hospitalization post an accident or due to complications from an existing illness. The claims process ideally must begin within 24 hours of hospitalization to save out of pocket expenses. The insured or their relative must send a preauthorization request to the TPA within a few hours of admission. The goal of the process is to validate the nature of emergency that can justify the hefty claim costs.

In cases when one can’t wait for insurance provider’s approval, it’s advisable to pay for the expenses upfront and claim a reimbursement later.

Process for Emergency Hospitalization:

  • Showcase your health insurance card
  • Wait for the pre-authorization letter from the insurance provider
  • Submit the letter and emergency letter

How to Evaluate Health Insurance Options

There are chances of confusion when you browse through the possible health insurance options, and that’s fine. However, you can rely on certain essential factors to help your decision, like:

  • The sum assured and the yearly premium: You can consider the policy if the premium is lesser and the sum assured is more.
  • No Claim Bonus: Many insurance providers offer a provision of no-claim bonus to reward people who haven’t made a single claim in a certain time period, say 1 or 2 years.
  • Network coverage: Make sure you have medical coverage available at close proximity to your residence. Apart from that, take a note if their best medical services are in line with the treatment options you might look at in the future, if it’s not an emergency admission.
  • Claims process: The simpler the claims process, the better. Always go for an insurance that allows you to leverage policy benefits with minimum documentation and a hassle-free claims process
  • Claims success ratio: It can be one of the determinants for your policy choice because you would want to have a successful claim even when you are paying a little more on the price spectrum.
  • Customer support: Reliable insurance providers offer a range of options to support customers, whether it’s chat, phone, or email support. It would be great if you can connect with existing policy holders to know about their experience and make an informed decision

The Way Forward

It’s true that you’re getting more health aware but you never know when an unforeseen health situation knocks at your door. Having a reliable health insurance policy that also offers a comprehensive network coverage of hospitals must be your priority.

Before signing on the dotted line for a healthcare policy, it’s a good practice to check out their list of network hospitals. If you are living with a prevailing condition or even comorbidities, you can take the call after closely observing the list of network hospitals’ coverage, their proximity from your residence, and top treatments on offer.

It’s essential for you to be aware of the know-how of network hospitals to ensure you navigate the process easily, just in case the need arises.

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