The terms inpatient and outpatient hospitalization are frequently used in health insurance policies. While the majority of policies only provide coverage for an inpatient hospitalization, several of them also include coverage for medical costs associated with outpatient hospitalization. Continue reading to learn the distinctions between inpatient and outpatient hospitalization if you’re not sure what they mean.
What is hospitalization for inpatients?
When a patient is admitted to a hospital for medical care, inpatient hospitalization takes place. Intensive monitoring and observation typically entail an overnight stay at the hospital. A stay in an inpatient hospital is typically necessary in the event of a medical emergency or for a planned procedure or procedure, such as surgery or treatment for serious burns, a traumatic accident, childbirth, chronic diseases, etc.
If the patient has been admitted to the hospital for at least 24 hours, then all health insurance policies will pay for inpatient treatment. However, the scope of insurance company coverage is restricted to costs associated with inpatient hospitalization for:
- Medical costs
- Room rental
- drug and medication
- Injection, intravenous fluids, and blood transfusion fees
- tests for diagnosis
- Consumables
- Theatre fees for operations
- Charges for the Intensive Care Unit (ICU)
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implants made during surgery for prosthetics and other items/devices
Let’s say Ram needs major open heart surgery to unblock the arteries after learning that his heart is 90% blocked. The doctor operated on him after requesting that he be admitted to the hospital right away. After two days of continuous surveillance in the ICU, he was eventually released after a week. Ram’s hospitalization in this instance falls under the in-patient category, hence his insurance provider will cover his medical expenses.
Let’s say Ram needs major open heart surgery to unblock the arteries after learning that his heart is 90% blocked. The doctor operated on him after requesting that he be admitted to the hospital right away. After two days of continuous surveillance in the ICU, he was eventually released after a week. Ram’s hospitalization in this instance falls under the in-patient category, hence his insurance provider will cover his medical expenses.
What is hospitalization for outpatients?
When a patient receives medical care without being admitted to a hospital, this is referred to as outpatient hospitalization. These procedures are carried performed in a hospital’s outpatient department, a clinic, or a diagnostic facility.
Only if health insurance coverage has the OPD benefit will it pay for outpatient medical bills. OPD coverage may be a built-in feature of some plans or an add-on benefit in others. The insurance provider will cover the following outpatient medical costs as part of the OPD benefit:
consultations with physicians
- Diagnostic procedures such as X-rays, blood tests, CT scans, MRIs, etc.
- the removal of cavities, root canal therapy, tooth extraction, etc.
- Minor operations that don’t require overnight observation
- Dialysis, chemotherapy, and other long-term disease therapies
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Medicines Rehabilitation
Let’s say Pooja visited a local doctor since she had a fever and a cold. The doctor identified her fever as viral, gave her some medications, and suggested resting. Pooja’s doctor visits and medication costs in this situation will be considered outpatient care and reimbursed by her insurer under the OPD policy.
Being admitted to a hospital and remaining the night or longer is known as inpatient hospitalization. For patients with serious diseases or those in need of surgery, it offers intense medical treatment, monitoring, and nursing support. On the other hand, receiving medical care without spending the night in a hospital is referred to as outpatient hospitalization. For consultations, examinations, and treatments, patients go to the hospital or other healthcare facility, then leave that same day to go home. While inpatient care is more extensive and expensive due to prolonged stays and round-the-clock care, outpatient care is more appropriate for less serious conditions and provides greater accessibility and flexibility.
Let’s say Ram needs major open heart surgery to unblock the arteries after learning that his heart is 90% blocked. The doctor operated on him after requesting that he be admitted to the hospital right away. After two days of continuous surveillance in the ICU, he was eventually released after a week. Ram’s hospitalization in this instance falls under the in-patient category, hence his insurance provider will cover his medical expenses.
