Difference between Network and Non-Network Hospitals
Difference between Network and Non-Network Hospitals
With rising medical inflation, hospitalisation expenses have significantly increased, leading to a substantial rise in the demand for medical insurance plans. When looking for a suitable health insurance plan in India, you may come across terms like network and non-network hospitals.
These insurance terms differentiate between hospitals that have tie-ups or collaborations with insurance providers and those that do not have any collaborations.
This guide will explore the differences between network vs non-network hospitals in detail.
What is Network Hospital Meaning in Health Insurance?
Network hospitals are healthcare facilities that have a partnership with insurance providers. Policyholders can enjoy certain benefits when they visit network hospitals, such as cashless hospitalisation services, easy claim procedure, etc., during medical crises.
Since these healthcare facilities work closely with an insurance provider, it is easier and more cost-effective for policyholders to receive the medical care they need.
For instance, person A has a medical insurance plan for XYZ company. XYZ has a wide network of empanelled hospitals and has partnered with ABC Hospital, where person A is admitted.
Since it is a network hospital, person A can receive cashless treatment per their policy terms and conditions with an easy claim filing process.
The medical bills will be settled by the XYZ insurance company and sent directly to ABC Hospital once the claim is approved.
Benefits of Network Hospital
-Cashless Treatment
Network hospitals have a dedicated procedure that allows policyholders to receive quality medical care without paying any upfront cost.
With the cashless treatment options, policyholders do not have to worry about the immediate financial burden during emergencies. It also eliminates the need to file reimbursement claims, providing a sense of security and relief.
Under a cashless treatment facility, policyholders do not have to pay any upfront cost for medical services to the hospital as per their policy terms and conditions.
Also Read: Cashless Claim In Health Insurance
-Quality Healthcare Services
Before partnering with any hospital, insurance companies conduct a rigorous evaluation and quality check to ensure the hospital offers quality healthcare services.
They ensure that the hospital has state-of-the-art equipment, enabling them to deliver advanced treatment services. This ensures that the policyholder will receive better healthcare facilities in the network hospitals.
-Cost Effectiveness
Another benefit of medical treatment in network hospitals is that they have pre-negotiated rates with the insurance companies, resulting in cost savings for policyholders. Policyholders can avail of medical treatment at discounted rates in the network hospital.
Additionally, out-of-pocket expenses are significantly smaller for policyholders as insurance companies cover larger portions of medical treatment costs based on the policy terms and conditions.
-Easy Claim Settlement Process
Network hospitals work closely with insurance providers, resulting in fewer administrative hassles and reduced paperwork for policyholders during claim procedures. Thus, network hospitals offer hassle-free claim services to policyholders.
What is a Non-Network Hospital Meaning in Health Insurance?
A non-network hospital is a healthcare facility with no tie-up or contract with the insurance company. Because these hospitals are not in direct contact with the insurance company, policyholders may not receive certain benefits, such as hassle-free claim settlements and reduced paperwork.
As per the new GIC (General Insurance Council) guidelines, individuals with eligible health insurance plans in India can receive cashless medical care in any authorised healthcare facility, regardless of whether it is tied up with an insurance company.
For instance, if person X has health insurance from XYZ company. While the insurance company has a list of network hospitals, person X was admitted to ABC Hospital, which has no partnership with XYZ insurance company. Hence, ABC hospital will be referred to as a non-network hospital in such conditions.
Similar to network hospitals, person X can seek cashless treatment in ABC hospital; however, the documentation will be lengthy compared to network hospitals. Apart from this, person X can also file a reimbursement claim by paying the medical treatment cost upfront.
Benefits of Non-Network Hospital
-Specialised Care
Many hospitals provide advanced treatments for specific diseases and have renowned professionals on their staff but might not be a part of an insurer’s network of hospitals. However, these hospitals may be particularly suitable for patients seeking top-tier medical care for complex or rare conditions.
Access to such specialised facilities and experts ensures that patients receive the highest quality of care tailored to their unique medical needs.
-Greater Control
Greater control over healthcare choices is a significant advantage when opting for non-network hospitals.
Patients are free to select any hospital or healthcare provider, ensuring they are not confined to the limited options within the insurance company's network.
This flexibility allows patients to prioritise their needs, preferences, and comfort, leading to a more personalised and satisfying healthcare experience.
-Location Convenience
Many of these hospitals are closer to patients' residences and easily accessible than network hospitals. This proximity can be crucial during emergencies, reducing travel time and enabling quicker access to medical care.
Additionally, a hospital nearby can be more convenient for follow-up visits, ongoing treatments, and the overall comfort of patients and their families.
-Cashless Treatment
Unlike before, when cashless treatments were only available at network hospitals, you can now get them at non-network hospitals too. Individuals with a health insurance plan can seek cashless treatment benefits in any authorised hospital in the country. However, the claim process and documentation may vary by hospital.
Network Vs Non-Network Hospital: Difference
| Parameters | Network Hospitals | Non-network Hospitals |
|---|---|---|
| Meaning | A network hospital is a healthcare facility that has partnered or tied up with an insurance provider. | A non-network hospital is a healthcare facility that has not partnered with an insurance provider. |
| Contract Agreement | These healthcare facilities have formal agreements with the insurance providers. | These healthcare facilities do not have any contract or formal agreement with the insurance providers. |
| Claim Process | The claim process with network hospitals is seamless as it is handled directly by the insurance provider and hospital. | In non-network hospitals, patients need to carry out the cashless claim procedure and submit all the necessary documents to the insurance provider. |
| Admission | The policyholder can inform the insurance provider in advance of planned hospitalisation. They can imitate the insurance company within 24 to 48 hours for emergency admission. | The policyholder can inform the insurance provider within 24 to 48 hours of admission in any non-network hospital. |
| Waiting Period | The network hospital does not have a waiting period. Once the claim is approved, the insurance provider settles the bills directly with the hospital. | The waiting period for claim settlement may vary depending on the insurance provider. It usually takes 10 to 12 days to settle the claim after approval. |
| Billing Process | For network hospitals, hospitalisation bills are usually settled by the insurance provider directly with the hospital. | In non-network hospitals, policyholders can seek cashless claim benefits but the documentation and claim procedure may be lengthy. |
Claim Procedure of Network Vs Non-Network Hospital
When it comes to filing a claim, both network and non-network hospitals have a procedure in place. Let us understand the procedure for both in detail.
-Claim Procedure for Network Hospital
In network hospitals, policyholders can use both cashless and reimbursement facilities. The **Step-by-**Step procedure is listed below.
-Cashless Treatment for Planned Hospitalisation
Step 1: If the hospitalisation is planned, go to the TATA AIG website and fill out the cashless claim form.
Step 2: Email a cashless claim form or intimation letter at least 48 hours before the scheduled treatment in a network hospital.
Step 3: After verifying the cashless claim form and other policy documents, we will send a confirmation letter and inform the network hospital about the claim.
Step 4: Upon arrival at the hospital, policyholders must submit the confirmation letter and health card to the staff.
Step 5: After that, TATA AIG will manage everything, and policyholders can focus on getting quality medical care in the network hospitals.
-Cashless Treatment for Emergency Hospitalisation
Step 1: In case of emergency hospitalisation, visit the TATA AIG website and fill out the cashless claim form within 24 hours.
Step 2: Submit the documents, such as the claim form, health insurance plan copy, insurance card, photo ID, address ID, etc., to the hospital authority.
Step 3: After receiving the documents from hospital authorities, we will issue an authorisation letter to the hospital for cashless treatment and settle the bills directly with the hospital.
-Claim Procedure for Cashless Treatment in Non-network Hospital
Step 1: Visit the TATA AIG website and fill out the cashless claim form to notify representatives about the cashless treatment within the time frame.
Step 2: The representative will verify the cashless claim form and other policy documents.
Step 3: After the successful verification, we will send a confirmation letter.
Step 4: Upon admission to the hospital, you must show a confirmation letter and health card to the hospital staff to start cashless treatment.
-Claim Procedure for Reimbursement in Non-network Hospital
Step 1: Visit the TATA AIG website and fill out the reimbursement claim form.
Step 2: Submit all the necessary documents, such as reimbursement claim forms, hospitalisation bills, diagnosis reports, pharmacy bills and more.
Step 3: After receiving all the documents from the policyholder, we will verify them thoroughly and, based on that, either approve or reject the claim.
Step 4: We will release the reimbursement amount if the claim is approved.
Step 5: The amount will be credited to the policyholder's registered bank account within 15 days.
Also Read:** Health Insurance Claims Process:** Cashless & Reimbursement
How to Choose Between Network and Non-network Hospitals?
When it comes to network vs. non-network hospitals, people often get confused about which one to choose. Below are some factors that may help you make an informed decision.
-Availability of Treatment
When choosing the hospital of your choice, the first thing to consider is the availability of the treatment option. It simply means that the hospital offers the necessary treatment plan you are looking for.
This might be a little tough if you need emergency treatment. However, for planned treatment, you will have time to explore hospital facilities, specialists, treatment plans, etc.
-Quality of Medical Care
The next thing to consider while choosing between network and non-network hospitals is the quality of medical care.
This can vary from hospital to hospital. To learn about the hospital care service, read old patients' testimonials, reviews, etc. This will help you understand whether the facilities offered by the hospital are up to the mark or not.
-Location of Healthcare Facility
Another deciding factor when choosing between a network and a non-network hospital is the distance from your residence. A hospital nearby will offer a shorter commute, which will save time, especially for medical treatments that require frequent follow-up visits.
Conclusion
Knowing about network and non-network hospitals will help make an informed decision when choosing a health insurance plan in India. A health insurance plan with a wide list of network hospitals is suitable.
TATA AIG is a renowned health insurance provider offering various plans catering to individual needs. From pregnancy insurance to critical illness coverage, health insurance for senior citizens, and more, everyone is covered.
With around 11,000+ network hospitals across the nation, we offer hassle-free medical service to all our policyholders. Furthermore, with our health insurance plan, policyholders can access cashless treatment facilities in any authorised network or non-network hospital.
To find a network hospital in your area, visit the TATA AIG hospital locator page, enter your city and click on the "Search" button. The page will display all the network hospitals in your area.
Disclaimer / TnC
Your policy is subjected to terms and conditions & inclusions and exclusions mentioned in your policy wording. Please go through the documents carefully.
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