What is a Non-network Hospital in Health Insurance?

Imagine rushing to the hospital in the middle of a medical emergency, but only to later find out that your insurance company will not cover the hospital bills. That’s when knowing what non-network hospitals and network hospitals in health insurance mean becomes extremely important.

Imagine rushing to the hospital in the middle of a medical emergency, but...

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Non-network Hospital in Health Insurance
Some Key Takeaways
Why is Sum Insured important?
Difference between Network and Non-Network Hospital

Situations where you use a Non-network Hospital
How to get reimbursement from a Non-network Hospital?
Advantages And Disadvantages of Non-network Hospitals
Need a few tips for filing a reimbursement request successfully?
New changes you should know about
Conclusion
Frequently Asked Questions

Non-network Hospital in Health Insurance

Non-network hospitals in health insurance are the hospitals that do not have tie-ups or collaborations with your insurance company. What this means is, that since there is no agreement in place between the two parties, you will not get the benefits of cashless treatment or cashless claims at these hospitals. A network hospital on the other hand is a hospital that has tie-ups with your insurer and hence you can get cashless claims at these hospitals.

Some Key Takeaways

-Non-network hospitals have no tie-ups with your insurance company.
-If you are admitted to a non-network hospital you are required to pay for the expenses upfront.
-You will need to collect all the relevant documents and bills and submit them to your insurance company for reimbursement only after being discharged from the hospital.

Why is Sum Insured important?

It acts as a financial shield or a safety net against healthcare costs.
A higher sum insured means more protection, especially if you are at risk of frequent hospital visits or illnesses.
At first it may seem like low sum insured can help you save on premiums, but it may fail to be a safety net for
you resulting in you having to pay huge expenses in the future.

Difference between Network and Non-Network Hospital

	Network Hospital	Non-network Hospital

Meaning	Hospitals that have a tie-up with your insurance company	Hospitals that do not have a tie-up with your insurance company
Payment	Upfront payment is usually not needed	Upfront payment is required
Type of claim	Cashless claims	Reimbursement
Documentation	Mostly handled by the hospital	Mostly handled by you
Approval time	Approvals for claims are pre-approved or in real-time	Approvals for claims are done post-treatment and may take time
Hospital choice	Can only choose from the list provided by insurance company	Can choose any hospital you want

Situations where you use a Non-network Hospital

There may be times when you may have no choice but to pick a non-network hospital. Here are a few examples of such situations:

When you need emergency care at the nearest hospital
When your hospital of choice is not on the insurer’s list
When you are traveling and are in a remote or rural area where there are no network hospitals available
When a doctor or specialist you want to consult is available only at a non-network hospital

How to get reimbursement from a Non-network Hospital?

Step 1

You need to pay the full hospital bill or all bills before being discharged.

Step 2

Collect all documents like pharmacy bills, doctor consultation slips, ID proof & policy details, full hospital bill, prescriptions, test reports, and hospital discharge receipts.

Step 3

Fill in the claim form provided by your insurance company, attach all the important documents, and submit it within the time told to you by your insurer.

Step 4

Your insurance company will verify the documents, evaluate your claim, and then transfer the funds into your bank account if the claim is approved.

Advantages And Disadvantages of Non-network Hospitals

You get freedom of choice when it comes to hospital selection

It provides better access in case you find yourself in a remote area

Non-network hospitals are useful in case of emergencies

You cannot enjoy cashless claim benefits

Approvals for reimbursement can take a long time

You are at risk of your claim being rejected by the insurance company

Handling and submitting documents can be an exhausting and time-consuming process

Need a few tips for filing a reimbursement request successfully?

Keep copies of all essential bills and reports.
Inform your health insurance company about your situation ideally within 24-48 hours of hospitalisation.
Follow the claims instructions given by your insurance company.
Double-check if the treatment or procedure is covered under your policy.
Make sure to maintain clear communication with the hospital and the insurance company.

New changes you should know about

The General Insurance Council (GIC) has introduced a ‘Cashless Everywhere’ initiative to make cashless treatment available even at non-network hospitals. It lets you use the benefits of cashless claims even if the hospital is not listed in your insurance provider’s network. This initiative aims to reduce out-of-pocket expenses and make the claim process for policyholders much easier.

Conclusion

The sum insured is not just a number on your policy, it is your financial safety net that will help you with your medical expenses. Choosing the right sum insured can make a big difference when life throws an unexpected health crisis your way. Understanding what sum insured does in your policy will also help you plan not just your future better but your loved ones too.

Frequently Asked Questions

Can I visit a non-network hospital and still use my health insurance?

Yes, you can. You will need to follow the reimbursement claim procedure as instructed by your insurance provider.

How can I check which hospitals are ACKO’s network hospitals?

You can find the list of network hospitals by checking our website, or mobile app, or by talking to an ACKO customer care representative.

What if I get admitted to a non-network hospital in an emergency?

In these cases, you can still file for reimbursement but make sure you inform your health insurance provider as soon as possible so you can collect the required documents at the earliest.

How to avoid non-network hospitals?

You can avoid non-network hospitals by preparing in advance and checking your insurance provider’s list of network hospitals on their website or mobile app, or even speaking to customer service. With this information, you can plan your surgery or treatment accordingly and avoid going to a non-network hospital.

Will my claim get rejected at a non-network hospital?

Not always. Rejection of claims will happen in cases where the treatment is not covered under your health insurance policy or if the documents provided are incomplete or missing.

Is a network hospital or a non-network hospital better?

It depends on the needs and the situation of the individual. If you require cashless treatment, then a network hospital is best. But, if you are in a remote area or in an emergency, then a non-network hospital would be best for you. Both network and non-network hospitals have their advantages and disadvantages.

Written by Roocha Kanade

2.5K Linkedin Followers

Reviewed by Dr. Harshita Dahiya

Health Insurance content enthusiast who turns complex topics into easy, binge-worthy reads—fueled by SEO, creativity, and way too much chai! Loves juggling multiple projects, cracking impossible deadlines, and sprinkling humor into the mix. When not geeking out over digital trends, you'll find her lurking on Quora and Reddit, planning the next getaway, or passionately decoding all things health and insurance!