The term network hospital should not give you goose bumps. I also did not know what it meant at first. The internet is here to provide you with answers to your questions. Network hospitals are hospitals that have insurance agreements with insurance companies. Policy holders using in-network hospital services enjoy more benefits. Cashless services are the best benefits enjoyed. With an insurance policy, you will get treatment from in-network or out-network facility. A non-network hospital is a hospital that has not entered into any agreements with the insurance company. At some point, visiting non-network hospitals will cost more. The policy holder might end up making cash payments. The policy holder will apply for the reimbursement of the amount spent after the treatment.
Benefits of using in-network hospital
Walking into a hospital and leaving without making cash payments feels like a free service. Your health insurance options will give you a list of hospitals that are in-network. From the list, you can choose to remain constant to one or use either. In these hospitals, you will not pay any money from your pocket. It feels like a burden is lifted off your shoulders. In case you use non-network hospitals, terms are different. The policy holder will pay from their pocket and apply for a reimbursement later. If you do not have the money what will you do? If you had a personal doctor from a non-network hospital, you might have to change that. The health insurance options are less but you have the best of them all. Cashless and reimbursement claims are the two claims that can be made. However, it is important to note that a cashless claim can be denied.
Cheaper treatment charges
Depending with the type of plan you have, you might need to make some partial payment. The insurance company will pay a large amount as you cater for the least. Visiting an in-network hospital will give you the chance to receive services at cheaper charges. Be kind to your pocket as you do to your health. Non-network hospitals will charge according to their terms. This is because they have not entered into any agreement with the insurance company. So, apart from making cash payments, you pay more than usual. If you can avoid such incidences stay away from them. Sometimes it could be an emergency and you rush to the nearest hospital. It is a valid reason but an insurance company will not understand that.
You will receive some benefits like less ambulance services. The in-network hospital knows that you are a policy holder with their affiliate insurance charges. Non-network hospitals have different charges. Do not forget that a hospital could be a non-network to your policy but an in-network for another insurer. This is why you should think twice before listening to friends who are policy holders with other companies.
Conditions under which a cashless claim can be denied
Seeking treatment at a non-network hospital. You already know what a non-network hospital is. A cashless claim is denied in this case because the facility is not an in-network hospitals. As a policy holder, you will pay the amount and claim for a reimbursement later.
Insufficient information from the hospital. Before a cashless claim is settled, the hospital will provide information about the treatment. Failure from the hospital giving enough information will lead to a claim being denied. The insurance company might think the hospital is not being honest.
The illness may not be covered under the policy bought. The insurance company will not settle claims on any illness not covered by the policy. This is where I suggest you do a scrutiny and know about your benefits. A policy holder should clearly know about the illness covered by the policy bought. This will help you not fall victim of unnecessary situations.
What to do if you have a non-network doctor
You could already be having a family doctor before applying for an insurance cover. After the approval you find out that your doctor is not an in-network doctor. What do you? There are two ways to go about this, the obvious one, getting another doctor. Not that you do not want him/her but the expenses are high and you cannot afford it. Now that you have an insurance cover, you should pay less for medical treatment. But replacing him/her is not always the best idea. It can even lead to broken relationship. There is a better way to do it. Contact your policy provider. Talk to your insurer and ask for your doctor to be added in the in-network facility. The two parties will get into an agreement and you will be able to keep your doctor. If this does not happen, option one may be the only way out. However, it is good to try any other available method first. But doctors are understanding and should not get hurt in case of being in such a situation.
There are different health insurance options available for you. A policy provider will guide you through the options and enlighten you. However, the final decision is your responsibility. Be sure that the option you choose will be convenient for you. Avoiding non-network facilities as possible as you can will save you a lot of hassle. You will not have to use your money and get a reimbursement later. You will not pay more than you should pay. You will stand a better chance to accessing more benefits if you use an in-network facility. A non-network facility should be the last option. It should click in your mind in case of an emergency and your in-network facility is far. From top to bottom, an in-network facility will provide you with the best services. You do not have to be consistent with one facility, you can use different as long as they are in-network.