Difference between Network Hospitals and Non-network Hospitals

Network hospitals VS. Non-network hospitals

In the US, private health insurance companies contract with hospitals to provide coverage and benefits for their members. Some hospital networks are exclusive, meaning that only patients covered by certain plans can receive care at those hospitals. Other hospitals are in-network and accept most plans.

If a patient chooses to visit a network hospital, he/she can expect to receive better service at an affordable price because many patients come there for treatment which makes it easy for them to earn more profit than non-network hospitals. This will also help them in improving their services so that they can attract more customers to their facilities.

On the other hand, if a patient chooses to visit non-network hospitals he/she has less chance of receiving good service because there are fewer patients who come there for treatment which makes it difficult for them to earn enough profit to improve their services.

8 Differences between Network Hospitals and Non-network Hospitals

Now that you understand the explicit difference in terms of the insurance paperwork, let us see how these hospitals affect your stay. Network or non-network hospitals both come with their own implications. 

1. Formalities

Excessive formalities and paperwork are the pain of this generation. Despite technology coming to the save, a lot of hospitals require formalities first and treatment later. The issue has been a subject of major medical debates. However, ground changes have been slow to implement. A network hospital saves you and your family from undergoing explicit paperwork formalities. On the other hand, non-network hospitals will require several checks before looking into your health insurance policy cover.

2. Urgent Cash

A non-networked hospital requires you to pay and have steady cash available at all times. This can make the process extremely cumbersome for people who save less and spend more. The sudden cash requirements tend to affect the monthly budget and sometimes even yearly expenses. Networked hospitals, on the other hand, do not require you to have steady cash. You can avail of the treatment and send the transaction bill to the insurance agency for payment.

3. Waiting period

The waiting period for a non-networked hospital can be very cumbersome. When you submit your hospital expense report, you might have to wait for some time before the insurance agency clears the due. This is because of the long period of verification process that undergoes in the clearance process. On the other hand, networked hospitals simplify the process by taking lesser time to clear your hospital dues. 

4. Cost management

The main benefit of having a network is that it helps manage costs for both insurers and patients. Insurers can negotiate rates with hospitals and doctors, which allows them to keep premiums lower than they otherwise would be. Patients also benefit from not having to worry about how much their care costs because their plan has negotiated lower prices for them.

5. Contractual Agreements

Non-network hospitals are those that do not have any contractual agreements with health insurance companies. They provide services to patients who come from out of state, who do not have insurance, or who want to pay for their own medical bills.

These hospitals are usually located near your home and are easy to access. You don’t have to go through a lot of paperwork or require referrals from your doctors in order to get treated at these facilities.

6. Inclusive Agreement

Network hospitals do not charge the patient for treatment, which means the patient will pay only their deductible and coinsurance. The insurance company pays most of the bill and then the balance is paid by you. Non-network hospitals charge the patient for all medical services rendered at their facility. This means that you will have to pay for your entire medical bill before you receive any reimbursement from your insurance company.

7. Profit evaluation

In health insurance plans with in-network providers, you will pay less because the plan has negotiated discounted rates with these providers. You can also use your HSA or FSA money to pay for out-of-network providers. However, you will have to pay the full cost of services out-of-pocket and then submit claims to your insurer for reimbursement.

8. Medical professionals

Hospital networks are created by health insurance companies so that they can negotiate lower rates with doctors and hospitals in exchange for being included in their networks. This allows them to offer lower premiums without sacrificing the quality of care. Some people may argue that this practice results in inferior care because patients may not get treated at the best hospitals or by their preferred physicians- but studies show that this isn't necessarily true.

Health insurance is a form of insurance that pays for medical and surgical expenses, whether the expense is covered by the patient or not. It may be paid by an employer, government program, or individual. It may be funded through a social insurance system or a mixed economy of funding sources.

You can visit get my policy to find affordable health insurance policy covers based on your location and need. Just add your details and kick start your journey to safeguarding your health.


By Author: Kate Smith | 05 May 2022
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