What Are Network Hospitals And Why Are They Important?

Health Insurance

Health insurance has become a necessity due to a significant surge in medical expenses. It works as a financial safety net during challenging times of medical crisis. Insurance companies offer a choice of hospitals in their network hospital list so you can get cashless treatment without paying money from your pocket. Moreover, with the cashless facility, you can avail quality treatment without worrying about arranging money at the last moment. Read the following sections to know more about network hospitals and their benefits.

What are Cashless Network Hospitals?

Every health insurance company has agreements with several hospitals to provide cashless treatment to its policyholders. These are called network hospitals and are an integral part of your health insurance policy.

Depending on the policy, your medical insurance company will provide cashless cover for hospital fees and expenses incurred before and after hospitalisation. This works only when you get treatment from a network hospital. Therefore, it is vital that you take note of the health insurance network hospitals in your vicinity. 

How do Network Hospitals Work?

Mentioned below are the points you should know to have a better understanding of how network hospitals work:

1. A health insurance company checks the efficiency and expertise of medical services provided before collaborating with a hospital. 
2. Following this, they prepare a network hospital list and provide it to the policyholders. 
3. This list changes from time to time depending on the quality of service provided by these hospitals. 
4. Individuals covered under cashless insurance will have to submit a form to the Third Party Administrator (TPA) before getting hospitalised. 
5. In case of an emergency, the claim process can be started 24 hours after hospitalisation.
6. The insurance company will cover the expenses mentioned in the insurance policy. You will only have to pay for services that the policy does not cover. 

Benefits of Availing Treatment at Network Hospitals 

In the present times, the importance of network hospitals has increased to a great extent. Given are some of the benefits of getting treatment at network hospitals. 

1. With network hospitals, you do not have to worry about losing valuable time. 

2. Your health insurance provider will cover all the medical expenses under the specified terms and conditions of the policy. 

3. Extensive bills will not weigh you down from getting quality treatment. Refer to your network hospital list to find a cashless hospital near your residence. 

Role of Network Hospitals While Seeking Health Insurance 

Network hospitals play a significant role while claiming health insurance benefits. It makes the process more convenient. Moreover, it will guarantee that the hospital will not overcharge the individual for the treatment and other hospital expenses. Network hospitals also ensure that the beneficiary gets the utmost comfort when they are hospitalised. The billing and mediclaim process also simplifies when one chooses to get treated from the network hospitals. 

Also Read: Cashless Health Insurance Policy: Coverage Of Cashless Medical Insurance & Their Types

Differences between Network Hospitals and Non-Network Hospitals

A network hospital is registered under an insurer’s list of hospitals that provide cashless treatment. When getting treatment from a network hospital, you have to contact the TPA to get a letter of authorization. The insurance company will then bear the expenses so that you do not have to spend money from your savings.

Unlike network hospitals, non-network hospitals are not registered under the network hospital list of health insurance companies. So, if you get admitted to a non-network hospital, you have to pay the bills from your pocket. 

Post-discharge, you have to submit the required documents. This involves a lengthy process of compiling and filing paperwork. The insurer will approve the expenses he/she finds reasonable. After a few days, the patient will receive the refunded amount. 

Pre-existing Diseases in Health Insurance

An individual suffering from a medical condition before purchasing a health insurance policy is said to have a pre-existing disease (PED). It is rather difficult to claim health insurance for PEDs. Policyholders have to undergo a waiting period of 2-4 years to get coverage for a specified ailment. 

On 10 February 2020, the Insurance Regulator and Development Authority of India (IRDAI) made significant amendments to the definition of pre-existing diseases.

As per the new clause, individuals who had their conditions diagnosed within three months of purchasing a health plan must be covered. Their conditions need to be registered on the pre-existing disease list.

Now your insurance policy can cover diseases such as asthma, diabetes, high blood pressure, thyroid, cancer, and more.  

List of Day-Care Facilities That Can Be Availed at Network Hospitals 

Day-Care procedures and facilities covered in network hospitals are:

• Eyes: Cataract surgery, foreign body removal from eyes, corrective surgery, tear duct surgeries 
• ENT: Septoplasty, Tonsillectomy, Tympanoplasty, Myringotomy with Grommet insertion and foreign body removal 
• Tongue: Incision, Excision, Glossectomy, destruction of diseased tongue and reconstruction
• Cancer treatment: Chemo and Radiotherapy 
• Heart: Coronary Angiography 
• Other Surgeries: Colonoscopy, Haemodialysis, Lithotripsy, Dislocation surgery, appendectomy and more 

Exclusions of Services in Network Hospitals

The exclusions of services in cashless network hospitals are:

• Treatment or hospitalisation due to self-inflicted injury, self-harm, suicide, done when sane or insane
• Hospitalisation due to war or chemical or biological weapons/ exposure to radiation
• Hospitalisation due to alcohol or substance abuse
• Treatment and hospitalisation due to HIV/AIDs if not specified that the insurance is covering this disease
• Congenital diseases like mental disorders if not specified in the insurance policy 
• Additional expenses like special diets and items of comfort and convenience 

How to Make Cashless Claims at Your Nearby Network Hospital?

Here is how you can make a cashless claim following a few easy steps:

Planned hospitalisation

1. Find the nearest network hospital from the list.
2. Download the pre-authorisation form from the TPA’s website. You can also find it in the network hospital’s TPA counter.
3. Fill up the form and submit it to the insurer of your chosen network hospital.
4. You will receive approval with the coverage details. 
5. Present your health insurance card or your policy number on the day of hospitalisation. Submit your authorization form along with it. 
6. Make sure that you submit the form within the time period of validity.

Emergency treatment

1. Fill up and submit the pre-authorisation form within 24 hours of hospitalisation.
2. The insurance desk stationed at the hospital will send your form across.
3. The insurer will likely approve your claim within a few hours.
4. Ideally, you should wait for the TPA’s approval. However, in case of urgency, you can pay the bills at that moment. Later, you can apply for reimbursement.

Also Read: Importance Of Cashless Hospitalisation: How Does It Work, Types and Benefits

Documents Required for Making Claims at Network Hospitals 

The various documents required to make claims during network hospital bill payments include:

• Duly filled and properly signed claim form
• Health card
• Medical certificates
• Valid ID proofs
• Hospital discharge summary
• All bills and receipts 
• Test reports like blood tests
• In case of accident copy of an FIR 

Final Word

It is advisable to keep a list of network hospitals for reference in case you need to get hospitalised urgently. With cashless claims, you can get treatment easier and without much hassle. Get yourself health insurance from  Navi App and free yourself from the burden of hefty hospital bills and concentrate on your recovery.  

FAQs on Network Hospitals

Before you go…

How about an affordable health insurance policy 👨‍⚕️ starting at a monthly premium of just ₹235? Install the Navi app now and get your policy in under 2 minutes.

Disclaimer: This article has been prepared on the basis of internal data, publicly available information and other sources believed to be reliable. The information contained in this article is for general purposes only and not a complete disclosure of every material fact. It should not be construed as investment advice to any party. The article does not warrant the completeness or accuracy of the information, and disclaims all liabilities, losses and damages arising out of the use of this information. Readers shall be fully liable/responsible for any decision taken on the basis of this article.