Network Hospitals in Health Insurance: Why They Matter More Than You Think

What is network hospitals in health insurance? Network hospitals are affiliated medical facilities that provide cashless care and have your insurer pay your medical costs. Finding one in an emergency can be difficult, so when selecting a health plan, always be aware of the network hospitals that are close by. Through easy cashless claims, these collaborations enable you to save upfront costs and guarantee quicker, less stressful access to healthcare.

Medical inflation in India is brutal. A single hospitalization can burn through ₹3–5 lakhs in days. And here’s the kicker: even if you have health insurance, you could still be swiping your card first if the hospital isn’t on your insurer’s list.

At Ditto, we’ve helped thousands of families navigate claims, and one thing is clear: network hospitals are the real backbone of a stress-free health insurance experience. For this guide, we’ve pulled from IRDAI’s latest rules, insurer tie-up practices, and real claim cases we’ve handled to explain how health insurance network hospitals actually work, why they matter in emergencies, and what to watch out for when you pick a plan.

By the end, you’ll know how to check your insurer’s list, how cashless claims really work, and why relying on non-network hospitals can land you in paperwork nightmares.

Still unsure about which health plan comes with the best network of hospitals. Talk to our experts at Ditto. Book your free call now.

What Are Network Hospitals?

Network hospitals are simply hospitals that have a tie-up with your insurer. The benefit? You don’t have to scramble for lakhs during an emergency. The hospital sends the bill to your insurer, and it’s settled directly under the cashless facility. That takes a massive weight off your family’s shoulders when every minute counts.

But not every hospital makes it to this list. Insurers only partner with hospitals that agree to pre-defined package rates for common treatments—say a cataract surgery or knee replacement. These packages usually bundle room rent, doctor’s fees, OT charges, and medicines. The upside? You’re shielded from inflated bills, and insurers can keep costs predictable.

Pro Tip: For a hospital to qualify as a “network” partner, it has to tick certain boxes put forth by the IRDAI. These include having proper infrastructure, transparent billing, and ideally an NABH accreditation. In addition, insurers/TPA must audit hospital bills, treatment records, and practices to make sure the hospitals on your insurer’s list can actually deliver good care without sneaky charges..

How to Avail the Cashless Facility at a Network Hospital of Your Insurer?

The cashless process is pretty straightforward:

Step 1 - Pick a hospital from your insurer’s network list.

Step 2 - At admission, show your policy card or policy number, after which a Cashless Facility request is sent to the Company for pre-authorization.

Step 3 - Once the request is approved, the insurer clears an estimated treatment cost and hospital stay (typically valid for 15 days). You can now begin treatment under cashless coverage.

IRDAI’s 2024 Master Circular mandates that insurers must approve cashless claims within one hour of receiving the request—so while you're at the hospital desk, your treatment approval should already be in motion.

Step 4 - During treatment, the hospital must submit a re-authorization request if treatment costs exceed the approved amount (treatment cost based on insurer’s package rates or hospital standard rates) . Without this, the insurer will cover only the earlier approved sum, and you may have to pay the extra, which can only be recovered later via reimbursement.

Step 5 - At discharge, you'll need to sign the final bill and only pay for any non-medical expenses (like consumables or registration charges), which are typically not covered by health insurance.

Did You Know? Many hospitals ask for a security deposit of around ₹10,000 to ₹50,000 before or during hospitalization. Though the insurers don’t mandate this, it’s a hospital practice to safeguard against pre-authorization delays, non-covered consumables, or possible claim rejections. The deposit is later adjusted against your final bill, and any balance is refunded once the insurer settles their share.

How Can You Check if a Hospital Is on Your Insurer’s Network List?

Not all hospitals that look familiar are covered under your policy. Here’s how to quickly verify whether a specific hospital and branch are in your insurer’s network.

• Website/App → Enter your city and search.
• Customer Support → Call the helpline and confirm.
• Policy Brochure → Sometimes lists hospitals, though it may be outdated.

IRDAI's 2024 guidelines require insurance companies to disclose their network hospital list on websites, policy packs, or support calls so you're never left guessing during a medical emergency. 

Another thing people often miss: always check the specific branch.

For example, “Apollo Hospital” might be covered in Bangalore’s Bannerghatta branch but not in Whitefield. If you assume all branches are included, you might be in for a rude shock.

At Ditto Insurance, we always recommend checking the insurer's network hospital list before picking a comprehensive health plan. Here's a quick look at insurers with a wide hospital network across India as of 2025:

Insurer	Network Hospitals
HDFC Ergo	13,000+
Aditya Birla	12,000+
Bajaj Allainz	12,000+
Care	11,400+
Niva Bupa	10,000+
ICICI Lombard	10,200+
Star Health	14,000+
Manipal Cigna	8,500+
Reliance General	10,000+

Pro Tip: Keep a shortlist of hospitals close to your home, office and other frequently travelled areas that are in your insurer’s network. That’s the list you’ll actually use in real life. It is also essential to periodically (once in 6-12 months) check the list as insurers often revise these.

What If You Use a Non-Network Hospital?

Health insurance doesn't always mean cashless. At non-network hospitals, you'll need to pay upfront and apply for reimbursement, which can be stressful during emergencies. Here's how reimbursement works and how the Cashless Everywhere scheme changes the rules.

Reimbursement

This is a little trickier than the cashless process, because here:

• You’ll have to pay the bill first.
• Only later can you apply for reimbursement with discharge summaries, prescriptions, and original bills.

Sounds workable? Maybe. But think about the practical side: Can you really swipe your card for ₹6 lakh during an emergency and wait months for repayment?

Here’s an interesting development though, IRDAI is pushing for a "shared hospital network" with standardized treatment rates similar to Ayushman Bharat. This action could make even non-network hospital claims more predictable, shielding patients from inflated bills and unexpected out-of-pocket costs.

What about the Cashless Everywhere Scheme?

“Cashless Everywhere” is a new initiative in Indian health insurance that allows you to get cashless treatment even at non-network hospitals. But there are a few conditions:

• The hospital must have at least 15 beds 
• It must be registered under the Clinical Establishments Act. This means you no longer have to restrict yourself to network hospitals for cashless claims.

Although the scheme offers flexibility to some extent, it is not foolproof. Approvals can be delayed, hospitals may refuse participation, and you might face back-and-forth negotiations. Thus, it should be viewed only as a backup option, not a replacement for choosing a network hospital with guaranteed cashless support.

Why Non-Network Hospital Claims Can Be a Hassle?

1.Documentation Issues in Claims:

One major challenge with non-network hospitals is managing the paperwork on your own. Unlike network hospitals, where insurers coordinate directly with the hospital, in non-network ones, you collect every document: discharge summary, bills, prescriptions, etc. The real issue? You often discover missing documents only after filing your claim.

Some treatments, like cataract surgery, require paperwork such as the lens invoice and identification sticker. Network hospitals usually know this, but non-network facilities may not provide them unless asked. This means even one missing detail can delay or reduce your reimbursement claim, turning a stressful experience into a paperwork nightmare.

2. Reasonable & Customary Clause:

At non-network hospitals, insurers don't pay the whole bill blindly; they compare it with the standard treatment cost in your city. You must pay the excess if your hospital charges exceed this "reasonable and customary" limit. This isn't a concern with network hospitals, where rates are pre-approved and aligned with insurer benchmarks.

3. Delays in Approval and Settlement:

Cashless claims at network hospitals are processed quickly because the billing team is aligned with the insurer's process. But with non-network hospitals, you're stuck with manual reimbursement, which means longer processing times, repeated queries, and risk of claim rejection due to formatting or missing info.

As per IRDAI rules, insurers must settle or reject health insurance claims within 30 days of receiving all documents. Delays beyond this trigger a 2% penalty interest above RBI's bank rate. Even if an investigation is needed, the entire process must still be wrapped up within 45 days.

Ditto’s Take on Health Insurance Network Hospitals

At Ditto, we’ve seen how minor oversights in choosing hospitals can make or break the value of your health insurance. Here are our top tips:

The Rule of 5

• Stick a list of 5 network hospitals on your fridge.
• Keep them within a 5–10 km radius of your residence.
• Choose them strategically—one for maternity, one for childcare, and at least one multi-speciality.
• Update the list if you shift cities or your insurer updates its hospital tie-ups. Because when emergencies hit, nobody has time to Google.

Watch Out for Blacklisted Hospitals

Certain hospitals get blocked for fraud, inflated billing, or repeated disputes. Once blacklisted, they’re excluded from both cashless and reimbursement. Insurers usually share this list in your policy document. Always check it because trusting the finances for your treatment to a hospital already flagged for malpractice is the last thing you’d want to do.

Did you know? The IRDAI, with the government of India, launched the National Health Claims Exchange(NHCX) to streamline medical insurance claims via digitally linking hospitals, insurers and TPAs. Even regulators are cracking down on inflated hospital bills and planning on centralized oversight portals. The aim? Faster claims, reduce disputes and increased transparency.

Prefer Near-Home Facilities

Reputation is excellent, but accessibility wins in emergencies. Having a trusted hospital just 5 minutes away could save more than money; it could save lives.

Why Choose Ditto for your Health Insurance?

At Ditto, we have assisted over 700,000 customers with choosing the right health insurance policy according to their needs and goals. Why customers like Amir love us:

✅No-Spam & No Salesmen

✅Rated 4.9/5 on Google Reviews by 12,000+ happy customers

✅Backed by Zerodha

✅100% Free Consultation

Conclusion

Your policy is only as good as the hospitals it gives you access to. Network hospitals mean cashless treatment, predictable costs, and far fewer claim disputes; non-network ones usually mean stress, delays, and money out of pocket.

If you’re choosing health insurance today, don’t just look at the sum insured or the premium. Make sure the right hospitals near you are on the network list, keep a shortlist handy, and double-check it every few months.

Because in the middle of a health scare, you don’t want to be doing research—you just want your insurance to work. Still unsure about which health plan comes with the best network of hospitals. Talk to our experts at Ditto. Book your free call now. 

FAQs on Network Hospitals