The hospitals which have a tie up with your insurer would come under the category of network hospital. The network hospital provides cashless facilities to the insured on approval by the insurer. The insured while getting admitted can quote his policy number or provide issued card by the health insurer to the hospital administration. The hospital will seek approval for treatment on your behalf. If approved, the payments will be settled by insurer subject to the cover taken by the insured.
What are non-network hospitals?
The hospitals which have no tie-up with the insurer are called non-network hospitals. If the insured seeks treatment in any of the non-network hospitals, the bills have to be settled by the insured himself. However the hospitalization expenses are reimbursed by submitting claim forms along with other documents to the insurer. On authentication, the expenses are reimbursed to the insured after deducting some amount as a deductible.
Why prefer network hospitals over non-network hospitals?
If you are admitted to a non-network hospital you need to settle the hospital bills yourself and then submit the hospitalization documents along with the claim form for reimbursement of hospitalization expenses.
Insurer would require the following documents for processing of your claim.
- A photocopy of your previous policy details prior to taking your Health policy (if applicable).
- A photocopy of your present policy document.
- First Prescription from the Doctor.
- The Claim Form duly signed by the claimant or family member.
- The Hospital Discharge Card
- The Hospital Bill giving detailed break up of all expense heads mentioned in the bill.
- The Money Receipt duly signed with a Revenue Stamp.
- All Original Laboratory & Diagnostic Test Reports. E.g. X-Ray, E.C.G, USG, MRI Scan, Haemogram etc.(Please note that you do not have to enclose the films or plates, a printed report for each investigation is sufficient)
- If you have purchased medicines in cash and if this has not been reflected in the hospital bill, you need to enclose a prescription from the doctor and the supporting medicine bill from the Chemist.
- If you have paid cash for Diagnostic or Radiology tests and it has not been reflected in the hospital bill, you need to enclose a prescription from the doctor advising the tests, the actual test reports and the bill from the diagnostic centre for the tests.
- In case of a Cataract Operation, you might have to enclose the IOL Stickers
This whole procedure can be tiring and frustrating. Along with the above procedure, there is a deductible applicable in case of non-network hospitals
In case of network hospitals, the insurer negotiates the treatment cost with the hospital and tries to get you the least possible rate and the best possible service. Also, you will not be required to directly pay for the medical expenses at the Network Hospital as long as the original bills and evidence of treatment in respect of the same shall be left with the Network Hospital. Also, there is no deductible in this case.
There fore it is better to go for network hospitals
To see a list of all the Bajaj Allianz network hospitals in your city, please follow this link: