How your health insurance will help if taking treatment at a non-network hospital

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October 04, 2021 4:25 PM

Health insurance companies on board a number of hospitals, clinics on their network. These networked medical facilities provide services to policyholders at a lower fee.

health insuranceRepresentative image

People buy health insurance policies for cashless mediclaim. And before buying it, they also check its network hospitals list to ensure one of them is in their vicinity. However, there are times when one has to take treatment at a non-network hospital. Does the health insurance policy help in such a situation, and how?

The answer is yes, the health insurance policy does help but not completely if taking treatment at a non-network hospital. Also, the experience is not as smooth as one may experience at a network hospital.

It is believed that the longer the list of network hospitals of the health insurance company, the easier it would be to find a hospital near you for making cashless mediclaim.

Health insurance companies on board a number of hospitals, clinics on their network. These networked medical facilities provide services to policyholders at a lower fee. In return, these hospitals and clinics get a regular inflow of patients who are the policyholders of the insurance companies.

However, when a person is admitted to a non-network hospital, he/she has to pay the full cost of treatment. They can submit all the treatment-related documents to the insurance provider to claim reimbursement. If the claims are found to be genuine by the insurance company then refunds are provided to the policyholder in 10-12 days.

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According to Aatur Thakkar, Co-founder and Director of Alliance Insurance Brokers, if a patient gets treated in a non-network hospital, it is difficult for him to avail the complete benefits of his health insurance policy.

Documents required

“The policyholder can file a claim for reimbursement after the entire medical treatment and after bearing medical expenditure out of the pocket. However, it is necessary to submit all the original supporting documents like medical reports, medical bills, etc,” Thakkar told FE Online.

“After checking all the documents and according to the underwritten policy, the total amount is refunded to the policyholder as per the claim settlement TAT of the insurer. Also, the Cashless facility provided in the network hospital will not be available,” he added.

Health insurance covers treatment in non-network hospitals also. But to make the claim, Ramchandra Pandit, head of the insurance business at Navi General Insurance, said, “The policyholder needs to submit his claim form with the medical records, relevant bills, and KYC document.”

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