The pandemic has highlighted the inevitability of uncertainties in our lives, showing that everyone, regardless of age, is vulnerable to serious health issues. This realization underscores the importance of having a health insurance policy and understanding the roles of network and non-network hospitals in settling claims.
Network Hospitals vs. Non-Network Hospitals
When you purchase a comprehensive health insurance plan, the insurer provides a list of network hospitals. These hospitals have agreements with the insurance company, offering policyholders the convenience of cashless hospitalization.
Amit Chhabra, head of health insurance at Policybazaar.com, explains that in a network hospital, patients do not need to worry about last-minute payments as the insurer directly settles the hospital bills, alleviating the financial burden on the policyholder. For expert guidance on selecting the best health insurance plan, contact iAdvisor for a consultation.
In contrast, if treatment is sought at a non-network hospital, the policyholder must initially cover all expenses and seek reimbursement later.
How Network Hospitals Operate
For planned hospitalizations, the insurance company and the network hospital are notified in advance. The policyholder or their dependents must complete a pre-authorization form, available at the hospital’s insurance desk or the third-party administrator’s (TPA) website. After submitting the form, the hospital verifies the details and notifies the insurance company. Upon approval, an authorization letter specifying the medical procedure cost is sent to the hospital, and the insurer pays the claim directly. This process typically takes 30 minutes to 2 hours, depending on the insurer.
Impact on Health Claims
In an emergency hospitalization scenario:
Case 1: Network Hospital
When admitted to a network hospital, the insurance company handles all expenses, and the patient can use the cashless claim facility via a TPA. The patient may need to pay for non-covered treatment components, and necessary documents are collected for records. Chhabra notes that medical expenses in network hospitals are usually reasonable due to the increased patient volume from insurers.
Case 2: Non-Network Hospital
When admitted to a non-network hospital, the policyholder must bear all costs upfront and later file for reimbursement. Aatur Thakkar, co-founder and director at Alliance Insurance Brokers, advises that the policyholder needs to submit all original documents, including treatment reports and invoices, for the claim process. The insurer then verifies these documents, and reimbursement, if approved, usually occurs within 10 to 15 days.
Recommendations
Using non-network hospitals can result in certain expenses not being covered by the insurance policy, even if they are reasonable and justified. For faster claim settlements, especially in emergencies, it is advisable to get treated at network hospitals. Ajay Shah, director and head of retail business at Care Health Insurance, emphasizes that network hospitals offer cashless hospitalization, eliminating the need for extensive paperwork and waiting periods associated with reimbursements.
Rakesh Goyal, director at Probus Insurance, recommends opting for network hospitals to avoid the hassle of reimbursement processes. Non-network hospitals should only be considered if necessary treatments are unavailable at network hospitals.
For personalized advice and to ensure you choose the best health insurance plan with optimal hospital coverage, contact iAdvisor for an insurance consultation.