Accidents and illnesses can happen anytime. Given this reality, having health insurance guarantees coverage for unforeseen events that could affect your health. Even those who like to live on the edge keep in mind that not having health insurance could put you in serious debt.
When it comes to healthcare, knowing which hospital to visit can affect how much you pay and the type of care you receive. If you’ve ever come across the terms Network hospital and Non-network hospital, you might be wondering what the difference is and why it matters.
In this article, we provide a breakdown to help you make informed decisions.
Network vs Non-network Hospital
Most insurance companies work with certain hospitals and doctors. They agree in advance on lower prices for services rendered to the insured (i.e. individual with the insurance). These healthcare providers are considered network hospitals.
If a hospital does not have an agreement with your insurance provider, they are considered as non-network hospitals. While non-network hospitals can still provide high-quality care, they can charge full price, which usually means you pay more.
Why do non-network hospitals cost more?
- You're probably paying the full price.
When health insurers don't have a contract/agreement with non-network doctors and facilities, they can't control what's charged for services. And the rates can be higher than the discounted rates from network hospitals.
- You may have to pay the difference.
If the hospital charges more than what your insurance agrees to pay, you may have to pay the difference. Many health plans list a maximum amount they will pay for certain non-network services. If the hospital charges more than your plan is willing to pay, you could be responsible for paying the difference, in addition to your deductible, co-payment, or co-insurance.
You can read this article: Premiums, Deductibles, and Co-pays: Differences
- Your share of the costs is different and is usually higher.
With network hospitals, you usually pay a co-payment (a fixed fee). With a non-network hospital, you are responsible for paying co-insurance (a percentage of the total bill), which can be much higher than the co-payment within the network.
You can also read: What is coinsurance?
Why do network hospitals matter?
Network hospitals are the backbone of any major health insurance plan, and understanding how they work is essential to maximising your policy's benefits. These networks are carefully selected groups of hospitals and medical centres that collaborate with the insurer to provide care to its customers.
Network hospitals usually give you access to trusted doctors and specialists since your insurance company must have already checked and approved them. In addition, the terms and conditions would have usually been negotiated in detail with the service provider.
As such, a network hospital offers you greater flexibility and more options for choosing healthcare institutions and professionals that meet your needs and preferences.
Factors to consider when selecting a network hospital
When evaluating a plan, it's important to review the list of their network hospitals and understand the levels assigned to each, as this will directly impact the quality of care you will receive.
For example, let's say a surgery costs $15,000, and your insurer agreed with a network hospital to pay $10,000. If you go to a non-network hospital, you may have to pay the extra $5,000 yourself. In a network hospital, you wouldn’t.
In addition to the quality of care, it's crucial to consider the closeness of the network hospital to your home and/or workplace. A high-quality hospital may be less beneficial if it's located far away. Checking the locations of the hospitals in your network ensures you can quickly access medical services when you need them.
Advantages of using network hospitals
1. Multiple trusted hospitals
When you use a network hospital, you can choose from several approved healthcare facilities that meet your insurer’s standards.
2. Access to approved specialists
Insurance companies usually have online services that will guide you on how to access specialists and hospitals closest to your location.
3. Lower hospital bill
If you are admitted to a hospital for more than 24 hours, insurance usually pays the hospital directly. If your stay is shorter, you may need to pay first but you can always request your claim later.
4. Easier claims process
Since there is usually a prior agreement between the insurer and the network hospitals (and they already have a database of information), claims would be processed faster and with fewer problems.
Conclusion
Before buying health insurance, take time to understand how hospital networks work. Choosing the right plan can protect both your health and your finances.
For a stress-free process and extra health benefits, consider our Health Cover. Through Turaco Insurance, we ensure you receive your claim after each hospital visit.
Read the success stories of people like you, who have benefitted from our health cover.
.svg)
