An Insight About Network Hospitals in Health Insurance

Health Insurances 229 views

When it comes to network hospitals, these are such hospitals which have a tie up with your insurer, hence come under the category of network hospitals. These hospitals provide the cashless facilities to the insured on the approval by the insurer. Moreover, the insured while getting admitted in a hospital can quote his policy number offered by his health insurance provider to the administration of the hospital. Then on your behalf, the hospital will look for the approval of the treatment. More to the point, once approved, the payments will be settled by the insurer which is subject to the cover taken by the insured.
However, before going any further it is important to know about non-network hospitals, what they are, and how do they function.

What are non-network hospitals?

Those hospitals which have no tie-up with the insurer are known as non-network hospitals. If the insured is looking for the treatment in any of the non-network hospitals, the insured have to settle the bills himself. However, one thing that needs to be mentioned here is the fact that the expenses of the hospitalization are reimbursed by submitting the claim forms along with submitting the other documents to the insurer. On the authentication, the expenses are reimbursed to the insured after deducting the some amount as a deductible.

Why should you prefer network hospitals over non-network hospitals?

Suppose if you are admitted to a non-network hospital, you need to settle the hospital bills for yourself, and then submit all the relevant documents regarding hospitalization along with the claim form in order to have the reimbursement of hospitalization expenses.

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In order to process your claim, the insurer would require the following documents:

  • One photocopy for the details of your previous policy prior taking the health insurance policy
  • One photocopy of your present policy document
  • Your first doctor prescription
  • The claim form duly signed by the family member or claimant
  • The discharge card of the hospital
  • The bill of the hospital, including the detailed break up of all the expenses mentioned in it
  • Duly signed money receipt along with the revenue stamp
  • Original diagnostic & laboratory test reports such as X-Ray, ECG, USG, MRI Scan, Haemogram etc
  • In case you have made a purchase of medicines in cash, and if it has not been reflected in the bill of the hospital, then you need to enclose a doctor's prescription along with the medical bill from chemist.
  • If you have made a cash payment for radiology or diagnostic tests, and it has not been reflected in the bill of the hospital, you need to enclose the prescription with the tests advised by the doctor along with the test reports and bills from the diagnostic center.
  • Whereas, in the case of a cataract operation, you might have to enclose the IOL stickers.

Well, this entire procedure can be very exhausting, tiring as well as frustrating. However, along with the above procedure, there is a deductible applicable, in the case of non-network hospitals.

While on the other hand in case of network hospitals, the insurer can negotiate the cost of the treatment, and help you out in getting the least possible rate along with the best possible service.

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Not only this, in fact, you don't have to directly pay for the medical expenses at the network hospital as long as the original bills along with the evidence of treatment in respect of the same shall be left with the network hospital only. In fact, there is no deductible in this particular case.

Thus, it is always better to go for the network hospitals.

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