In-Network and Out-of-Network Hospitals- What your health insurance covers!

Every health insurance provider joins hands with a list of hospitals and healthcare centers to form a close network. Each hospital within this network is referred to as Network Hospital of that particular insurance provider. While certain medical practices like diagnosis and surgeries can be planned well ahead at a Network hospital, the same cannot be accomplished in during emergencies.

So what happens when an insured individual is treated in a hospital outside the network of the insurance provider? What are the differences that one experiences in dealing with hospitals in and out of the Network?

Read on to find out more details about hospital networks associated with insurance providers.

Cashless Hospitalization through Network Hospitals

Reputed health insurance providers offer “cashless hospitalization” through their network of hospitals in any particular region. Cashless hospitalization refers to the situation where the insured individual avails the required medical services without paying any fees from his or her pocket. Instead, the hospitals collect the hospitalization charges directly from the health insurance provider. The required documents must be submitted at least a few days prior to availing the treatment and approval for cashless hospitalization will be provided if the treatment is covered under the policy of the individual.

What expenses can be covered under cashless hospitalization?

Miscellaneous expenses such as food, travel, medical kits, ambulance fees and toiletries will not be covered under cashless hospitalization. The pre-authorization form obtained from the insurance provider will contain all details pertaining to costs covered and the validity of the authorization.

Availing treatment outside the hospital Network

An accident in the untimely hours of the night or a medical emergency while travelling to a remote area are instances when individuals cannot force themselves to choose a network hospital of their health insurance provider. In such cases, where time is a major constraint, treatment is availed from the nearest hospital and the insured patient becomes ineligible for cashless hospitalization. However, the reimbursements pertaining to the treatment can be availed later by submitting the appropriate documents with the insurance provider.

When choosing an insurance provider, make sure that they offer a significantly strong network of medical treatment facilities around where you live, work and frequent.