Inpatient vs Outpatient Hospitalisation In Health Insurance

Medical treatments and surgeries can be classified into inpatient and outpatient care. While both types provide medical care, they differ in terms of where, for what duration patients are treated, and how they pay for it. Knowing whether you are an inpatient or outpatient is essential if you seek medical treatment and have a health insurance policy that will cover your medical expenses. So, what is the difference, and why does it matter?

Read on to learn about inpatient hospitalisation vs. outpatient hospitalisation.

The term ‘inpatient’ refers to someone who is admitted to the hospital for medical treatment. Most patients enter the inpatient hospitalisation through a pre-planned surgery or treatment or during emergencies. Inpatient care requires an overnight stay, whether briefly or for extended periods of time. In most cases, patients require in-depth observation and monitoring. Most of the hospitalisation falls under this and it is the most basic coverage of health policies. To categorise you as an inpatient and to receive the benefits of the insurance policy, you need to be admitted to the hospital, either planned or unplanned, for 24 hours.

For example, Mr. A suffered a heart attack and required surgery to clear the block in his artery. His doctor advised him to admit himself to the hospital for the required procedure. Mr. A was required to stay in the hospital for more than 24 hours for the surgery and required in-depth monitoring and observation by healthcare professionals. In this case, most health insurance policies cover such inpatient hospitalisation.

Other examples:

The term ‘outpatient’ refers to someone who requires medical care but without hospitalisation. Outpatient medical care includes doctor consultations, diagnostic tests, rehabilitation, etc. These procedures are conducted outside the hospital settings such as clinics, diagnostic centres, etc.

Health insurance coverage for outpatient hospitalisation is usually not covered until specified in the terms and conditions of the policy. If you foresee multiple doctor consultations in the near future, opt for a health insurance plan covering outpatient expenses. You can also include Out-patient Department (OPD) cover as an add-on to your base plan.

For example, Mr. B was suffering from the viral flu. He consulted a doctor at a nearby clinic. His doctor prescribed a few medicines and advised Mr. B to take enough rest and did not require in-depth monitoring or observation. In this case, some health insurance policies provide coverage for outpatient medical expenses.

Other examples:

Here are the differences between inpatient and outpatient hospitalisation.

Health insurance plans typically offer higher coverage limits for inpatient hospitalization compared to outpatient treatment. When you require inpatient care, such as staying in a hospital, undergoing surgery, or receiving intensive care, there are various expenses involved. These expenses may include room charges, fees for using the ICU, costs for using the operation theater, doctor fees, nursing charges, anesthesia, and more. In such cases, insurance companies provide a larger coverage limit, reimbursing a significant portion of the expenses incurred for your treatment. It's worth noting that many insurers have a network of hospitals where you can avail cashless treatments. Given the increasing costs of medical care, it's crucial to purchase a comprehensive health insurance plan that covers the expenses related to treatment and hospitalization.

Hopefully, you have learned a little more about inpatient and outpatient hospitalisation. Understanding the difference between inpatient and outpatient hospitalisation can help you identify the right type of plan for you and your family, when you are planning ahead for medical treatment or procedure, or anticipating medical expenses for both types of patient care.