Network vs non-network hospitals in health insurance – What is the difference?

Picture this: you’re not feeling well and need to go to the hospital. Your health insurance depends greatly on how much you pay and how easy the process is. Choosing a hospital that is or isn’t in your insurance network can change your costs and how smoothly things go. Knowing the difference between network vs non-network hospitals in health insurance in the UAE can help you make better choices. This guide will explain these differences and what you need to think about, so you can find the best healthcare options for you.

Network hospitals in health insurance in the UAE:

Imagine being in a hospital bed, focusing on getting better without worrying about bills. That’s what network hospitals in health insurance are like. They’re like trusted friends in your insurance company’s family, making healthcare easy and stress-free.

Network hospitals have a special deal with insurance companies. You don’t need to pay anything upfront when you get treatment there. The insurance company pays the bills directly with the hospital so that you can pay attention to your recovery.

An example of the cashless claim:

A cashless claim means you don’t need to pay for your hospital treatment yourself. Instead, your insurance company covers the costs directly.

Here’s how it works:

1. Choose a network hospital: Find out if the hospital is on your insurance company’s list of network hospitals. This info is usually available on their website or app.
2. Pre-authorization: Before starting treatment, the hospital will get approval from your insurance company. They check that your insurance is active and covers the treatment you need.
3. Relax and recover: The hospital handles all the paperwork and billing with your insurance company. You can focus on getting better without worrying about paying bills.

Example:

Sarah needs to be hospitalised for liver disease. She finds a hospital on her insurance company’s network list. When she is admitted, her family contacts the hospital’s insurance desk. They fill out the necessary forms for cashless treatment. Once approved, Sarah’s insurance company pays all the hospital bills directly.

An example of the reimbursement claim:

If you didn’t use cashless benefits, you might need to pay for your treatment upfront and then get reimbursed.

Example:

Sarah has surgery at a network hospital and pays the hospital bills out of her own pocket. After she gets discharged, her family submits the bills to the insurance company. They then receive reimbursement for those medical expenses.

Non-network hospitals in health insurance in the UAE:

Non-network hospitals are medical facilities not listed under your insurance company’s approved network. While they don’t offer cashless treatment, they can be used in certain situations. However, you may face higher out-of-pocket costs or a more complicated claims process.

When to use non-network hospitals?

1. Emergency situations: The closest hospital may be outside your network when you need immediate medical care. In such cases, getting to the nearest medical facility is the priority, even if it’s not part of your insurance network.
2. Geographical convenience: If you live far from any network hospitals or are travelling within the UAE, a non-network hospital may be your only or most accessible option.

How to handle a non-network hospital claim?

Before deciding to go to a non-network hospital, always consider the following:

1. Review your policy: Check your health insurance policy to understand the coverage for non-network hospital visits. Know what percentage of costs may be reimbursed and what out-of-pocket expenses you might have.
2. Claims process: Be prepared for a more involved claims process, as non-network hospital reimbursements can take longer and require more documentation than claims within the network.
3. Documentation: Keep detailed records of all treatments, receipts, and medical reports, as these will be necessary for filing a reimbursement claim with your insurance company.

Network vs non-network hospital in health insurance in the UAE – A comparison

Feature	Network hospital	Non-network hospital
Upfront payment	No need to pay upfront (cashless)	You pay the full amount yourself
Claims process	Easy and handled by the insurer and hospital	You need to submit documents for reimbursement
Convenience	Very convenient, with little paperwork	Less convenient with more paperwork
Cost coverage	Insurance covers most costs at network hospitals	You might need to pay more out-of-pocket
Choice of specialists	Usually have many specialists available	Quality and choice may vary as they are not tied to insurance companies

Difference between network vs non-network hospitals in health insurance in the UAE:

Knowing the difference between network and non-network hospitals helps you make better choices about your healthcare and finances. Here’s a simple breakdown:

Let’s look at the claim process of both types of hospitals:

Feature	Network hospitals	Non-network hospitals
Notify your insurance	Inform the insurance company or TPA before a planned hospitalisation. For emergencies, notify within the time frame mentioned in your policy.	Inform your insurance company about your treatment plans or emergency immediately.
Pay upfront	No need to pay upfront. Treatment costs are covered directly by the insurance company.	You need to pay the hospital bills yourself at the time of treatment.
Collect documents	The hospital handles all the paperwork and billing directly with the insurance company.	Collect all medical bills, receipts, and treatment records from the hospital.
Submit for reimbursement	It is not required, as billing is handled directly by the insurance company.	Fill out the reimbursement form from your insurance company, attach all collected documents, and submit them.
Follow up	The hospital handles billing and insurance claims.	Check the status of your reimbursement claim with your insurance company and provide additional information if needed.

Network vs non-network hospitals in health insurance in the UAE – Which one to choose?

Network and non-network hospitals have some key differences. Knowing these can help you decide which is better for your needs. Here’s a simple comparison:

Feature	Network hospitals	Non-network hospitals
Financial convenience	No upfront payment; insurance handles bills.	Pay upfront and get reimbursed later; it may cost more.
Access to specialists and treatment	Often focus on specific types of care with specialised equipment and experts.	Choose if you need special treatments or experts, not available in-network hospitals.
Personal control and flexibility	Easier with set processes and fixed rates, but fewer choices for doctors and treatments.	More freedom to choose doctors and treatments, but involves more paperwork and possible delays.
Quality of care	Generally high due to regular insurance checks, but varies by hospital.	It can also offer high-quality care, but depends on the specific hospital.

Steps to choose between network and non-network hospitals in the UAE:

1. Check your insurance policy: Look at what your insurance covers for network and non-network hospitals. See if there are any limits or exclusions.
2. Consider your medical needs or emergency: Decide if you need special care that might only be available at non-network hospitals or if you are stuck in an emergency where the nearest hospital is a non-network hospital.
3. Compare costs: Compare the cost differences between network and non-network hospitals. Consider your deductible, co-payments, and how much you might be reimbursed.
4. Check hospital quality: Research both types of hospitals. Look at their reviews, ratings, and certifications.
5. Ask your insurance provider: If you need more clarification, contact your insurance company for advice on which hospitals offer the best coverage.

What’s the final takeaway?

Knowing the difference between network vs non-network hospitals in health insurance in the UAE is important. Network hospitals usually help you save money and have easy billing, while non-network hospitals give you more options and special care in an emergency. By knowing these differences and thinking about your healthcare needs, you can decide which option is best for your budget and health.

For those looking to navigate these choices more easily, InsuranceMarket.ae, a leading insurance broker in the UAE, provides valuable insights and guidance to help you find the right balance between coverage and care without the hassle.

Frequently Asked Questions (FAQs):

Q. What is the difference between network and non-network hospitals?
Network hospitals let you use your health insurance without paying upfront. Non-network hospitals do not offer this. Instead, you pay the bills first and then ask your insurance to pay you back.

Q. Can I get emergency care at a non-network hospital?
Yes, you can get emergency care at any hospital. But, how you get reimbursed may vary.

Q. Will my insurance cover all costs at a network hospital?
Insurance usually covers most costs, but check for any co-payments or exclusions.

Q. Are there extra benefits for using network hospitals?
Some insurance plans offer extra benefits like wellness programs or discounts at network hospitals.