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While purchasing health insurance, it is essential to look at the various components that make up the plan. One such important feature is the list of network hospitals. To avail the benefit of cashless treatment, the person must get hospitalized at their insurer’s network hospital. Make sure that the insurer of your choice has a long list of network hospitals with many of them in your residential vicinity so that it becomes more convenient for you during emergencies.
What happens if the insured gets hospitalized in a non-network hospital?
For better understanding, let us look at the difference between network and non-network hospitals:
Network Hospitals
In simple words, health insurance companies have tie-ups with a list of hospitals, medical professionals, clinics, etc. If you get admitted at one of these, the hospital settles your bills with insurer directly and you don’t have to pay anything.
All you have to do is avail the treatment at any hospital mentioned in the insurer’s list. But before availing treatment, you need to submit a form to the Third-Party Administrator (TPA) for cashless mediclaim. The patient can only seek treatment after the cashless claim has been approved. The insurance company will bear all the bills by coordinating with the hospital directly. You don’t have to submit any documents or bills. However, the expenses not mentioned in the policy document must be borne by you. Another task that should be considered is insurance renewal as you can only claim a valid policy.
Non-network Hospitals
It is possible to avail cashless treatment even if you are not hospitalized at one of your insurer’s network hospitals. In this situation, you will have to pay for the entire treatment on your own for the moment. Once the treatment is over, you must submit the necessary documents as well as the hospital’s original bill to your insurance provider. Your documents will be checked and approved if they find it reasonable and you will be reimbursed in a few days.
It is important that you opt for health insurance with the cashless facility or you won’t be able to enjoy the benefits of getting hospitalized in a network hospital even if you are in one. To avail these benefits, make sure that you are aware of the process to avail the claim & followed all required steps.
With the help of a cashless mediclaim policy, you can get the treatment in a network hospital. You must always have the list of the network hospitals provided by your insurance company with you as it can come in handy in case of sudden hospitalization. You must know the nearest hospitals in the list as well.
Be it an individual health plan or group health insurance for employees, make sure you check the list of network hospitals. However, if any of the network hospitals do not provide the treatment that you require, you can go to any non-network hospital to avail the treatment and be reimbursed for the same.
