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We can never gauge the life-threatening conditions that may arise which makes it pivotal to have health insurance. Health insurance is among the best ways to ensure that medical bills incurred as a result of illness, surgery, or an accident are covered. But, what if your medical claims are denied?
It is pointless to have a health insurance policy and not understand the circumstances in which your health insurance claims may be denied. By keeping track of a few simple things, you can avoid problems during the claim settlement of your mediclaims. Even well-informed people are unaware of some facts, such as the differences between inpatient and outpatient(opd) care in health insurance.
Medical procedures and surgeries are divided into two categories: inpatient and outpatient care. Although both types offer healthcare services, they vary widely in terms of where patients are treated, how long they are treated, and how they pay for medical facilities.
If you seek medical attention and have a medical insurance policy that covers your medical expenses, understanding whether you are an inpatient or outpatient is important.
So, what's the major difference, and how does it matter?
What is In-patient Care?
Inpatient hospitalization is when you are hospitalized for 24 hours or more and receive medication and treatment. There is a distinction between being hospitalized for 24 hours or more, being sent to the hospital for specific diagnostic tests, and being asked to go to the emergency department for immediate treatment. When a hospitalization lasts less than 24 hours, it is not considered an inpatient hospitalization.
What is Out-patient Care?
Do you know what is OPD? Outpatient treatment or opd is one in which you receive medical care without being admitted to a hospital. Doctor consultations, multiple diagnostic tests, and medications could all be part of the treatment. If you go to the hospital for same-day surgery and your hospitalization is less than 24 hours, such treatments may be covered by your health insurance policy as daycare treatments.
Difference Between In-patient and Out-patient Treatment
| In-patient | Out-patient |
|---|---|
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When a patient is formally admitted to a hospital for more than 24 hours or for an extended period of time, the patient is referred to as an inpatient. |
When a patient does not necessitate formal hospitalization for more than 24 hours and instead requires treatments undertaken outside of the hospital setting, the patient is referred to as an outpatient. |
|
Cost significantly higher than outpatient care. |
Cost significantly less than inpatient care. |
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Long-term medical care is required for complex surgeries, traumatic injuries, and severe illnesses. |
Short-term medical care includes annual blood tests, minor surgeries, medical screenings, and treatments that do not necessitate hospitalization. |
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Specialists and a broader group of healthcare providers (physicians, surgeons, nurse practitioners, pharmacists, physical therapists, etc). |
Specialists and primary care physicians (physician assistants, physical therapists, etc.) |
In-patient & Out-patient Treatment in Health Insurance
The health insurance plan may cover the cost of outpatient treatment at network hospitals on a cashless basis. It provides reimbursement for diagnostics, doctor consultations, and pharmacy bills if the treatment is received at a non-network hospital. In general, insurance companies provide health plans with higher coverage for inpatient hospitalization than outpatient treatment. Room rent, ICU charges, operating room rent, doctor expenses, nursing fees, anesthesia, and other expenses may be incurred during inpatient treatment. As a result, in the case of inpatient hospitalization, the insurance company provides a huge cover, that will reimburse several treatment-related expenses. In general, cashless treatments are available in the insurer's network of hospitals. Given the rise in medical costs, it is important to get comprehensive health insurance that covers the cost of treatment and hospitalization.
Do You Need Out-patient Cover in Your Health Insurance?
The kind of medical care you need will determine if you need inpatient or outpatient care. Purchasing health insurance with OPD coverage is a must in recent times for these two reasons:
A sedentary lifestyle is causing an increase in chronic conditions, which raises the overall cost of medicine. It is important to have a health insurance policy that covers inpatient care benefits to cover daily medical expenses without worry.
Since we lack an organized national health records system, insurers are extremely cautious about covering risks. With an OPD care plan, one can receive the best outpatient care while avoiding the repercussions of operational issues.
To Sum it Up!
Most insurance policies are designed to cover inpatient care that necessitates you to be hospitalized for 24 hours or more. Some plans, however, are designed to cover outpatient medical care. Before you could choose the best health plan for you, you must first confirm the policy's terms and conditions. Care Health Insurance offers Care Plus, a Youth Health Insurance Plan that gives coverage for out-patient consultations and also covers out-patient dental and ophthalmic treatments depending on the sum insured.
Hopefully, you now have a better understanding of inpatient and outpatient hospitalization. When planning for medical treatment or procedure, or anticipating medical expenses for both types of patient care, knowing the difference between both inpatient and outpatient hospitalization can help you identify the right type of plan for you and your family.
Disclaimer: The above information is for reference purposes only: Policy Assurance and Claims at the underwriter's discretion.
