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Health Insurance Claims: Network, Non-network, Reimbursement or Cashless?

Team AckoJul 22, 2021

Hospitalization can be tough for a lot of families. It is not just the patient who suffers, the entire family is affected by hospitalization in one way or the other. Besides, the ever-increasing medical costs always play on the minds of middle-class Indian families. In such a scenario, a health insurance policy works as a support system.

Types of claim settlement routes in health insurance

Medical insurance in India offers the necessary financial cushioning and as a result reduces some mental trauma. The assistance provided by insurance companies during claim settlement plays a huge role in stress management of the insured person. Usually, things move smoothly as insurance companies have tie ups with hospitals for smooth claim settlement. Such type of hospitals are termed as network hospitals by the insurance companies.

Read ahead to know more about such type of arrangements in the field of medical insurance in India.

Types of claim settlement routes in health insurance

Listed below are three types of health insurance claim settlement routes one can opt for in India.

  • Option 1 – Non-network Reimbursement: Consider a scenario where the insured person is hospitalized in a non-network hospital. Here, the insured will have to pay the hospital bills and deal with the hospital on their own. The insurance company will come into the picture after the bills are paid by the insured. After bill payment, the insured will submit the invoices to the insurance company, and they will conduct their own verification. Once the bill and the claim are found to be authentic, the insurance company will reimburse the claim amount (as computed by their claims team).

  • Option 2 – Network Reimbursement: Option 2 is similar to the first one with respect to the reimbursement clause. The insured/insurance company doesn’t have a cashless facility. However, since the insurance company has a basic tie up with the hospital, the claim settlement process might be smoother as compared to a non-network hospital.

  • Option 3 – Network Cashless: Here, the insured is not required to pay hospital bills upfront and thus there is no reimbursement clause involved. The insurance company settles the bill directly with the hospital. The insured just has to pay nominal charges. This is the best option in terms of convenience.

Also, read: 8 Tips to Save Hospitalization Bills with Health Insurance Policy

Why would insurers want a network of hospitals?

A vast network of hospitals helps insurance companies to process claims swiftly. Since they have a tie-up with the hospitals, they know how the hospitals functions and are well-versed with the kind of services it offers. This makes the claim verification process a lot easier.

Why would hospitals want to be a part of the insurance company’s network?

An insured person is most likely to visit a network hospital in case of health hazard as compared to a non-network hospital. Therefore, network hospitals get a competitive advantage in such a scenario.

Also, read: Employee Group Health Insurance

Win-win Situation

As per the above-mentioned points, cashless facility and network hospitals create a win-win situation for all stakeholders involved i.e. the insured person, the insurance company, and the hospital.

Online Health Insurance

Online health insurance is another facility that makes life easy for policyholders. Nowadays, you do not have to rely on an agent or visit an insurance company’s branch office to avail health insurance. The same can be done by sitting in your couch, at midnight via a smartphone! You are not restricted by time or influenced by anyone; you read, understand, compare, purchase, and get insured.

Online insurers provide information in a lucid manner on their website. However, if you are unable to understand the inclusions and exclusions of the policy, you can contact the insurance company’s call center and get all the answers. Make sure to make an informed choice while purchasing your health insurance policy online by reading the terms and conditions thoroughly.

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