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Can Health Insurance Claims be Made Even with Less than 24 Hours Hospitalization?

Any gadget we buy comes with a warranty period clause which states that in case of any manufacturing related defects, the company would bear the cost of related services. Thus, whenever we get our products serviced within the warranty period, we are relieved of the inherent expenses but what about after the lapse of the warranty period? We wonder how much would the cost of the service of the appliance be.

A similar condition is inherent in our health insurance plans. Health insurance promises great benefits but when it comes to claim settlement, we run from pillar to post to ensure that the financial burden of the hospital bills do not fall on our shoulders and the claims get duly settled. We enlist the help of our brokers to complete the claim settlement procedure in complete tandem with the mentioned formalities. Such a horror in getting the claim settled! But why?

Settlement of claim in a health insurance plan comes with a lot of strings attached. There are certain conditions which are to be fulfilled to get the claims settled. For a claim to be admissible the ailment should be covered by the plan, the insured should be admitted in a hospital which meets certain qualifying criteria, the claim should be properly filed and the hospitalization should be for at least a period of 24 hours.

Yes, the last requirement leaves many of us stumped. Normal hospitalization claims are settled only after the insured is hospitalized for a continuous period of 24 hours. But what about treatments which do not require a continuous hospital stay? Can we claim insurance benefits for such treatments too?

Yes, actually we can! Ever heard of Day Care Treatments? Every health insurance plans cover Day Care Treatments and this feature covers treatments availed which do not require hospitalization for 24 straight hours. Let us understand:

As defined by the policy wordings, Day Care Treatments are defined as those medical treatments or surgical procedures which are undertaken under the influence of a general or a local anaesthesia in a hospital or in a day care centre in less than 24 hours because of technological development in medicine which would have otherwise required a hospitalization of 24 hours.

Your health insurance plan covers these day care treatments which do not require a 24-hour hospitalization. Some common Day Care Treatments included in the health plans include:

  • Cataract surgery
  • Tonsillectomy
  • Chemotherapy and Radiotherapy
  • Hemodialysis
  • Coronary angiography
  • Nasal sinus aspiration
  • Free skin transplantation
  • Arthroscopic knee aspiration

These are some of the few treatments covered in a long list of treatments. However, you should note that Out-Patient Expenses like doctor consultations, tests and investigations are excluded from the scope of day care treatments though they might also require hospitalization for less than 24 hours.

OPD treatments differ from Day Care Treatments in the sense that OPD treatments do not require hospitalization at all irrespective of technological development in medicine. Day Care treatments on the other hand require hospitalization but the duration is reduced because of medical developments.

So, the next time you fear that your Cataract operation would not be covered or that your Chemotherapy session would be excluded from your health insurance coverage, think again. These fall under the scope of Day Care Treatments and such treatments are covered by your health plan.

All insurers provide coverage for Day Care Treatments and the only difference is that the list of treatments and surgeries covered vary from insurer to insurer. Moreover, these treatments also provide the facility of cashless claim settlement. Even if you cannot claim the cashless facility, reimbursement of such claims is also possible.

So, treatments shorter than 24 hours are Day Care Treatments and they are covered. The next time you worry that your hospitalization was not for the stipulated 24 hours, relax! The coverage for Day Care Treatments is there and it would come to your rescue. Just make sure you are claiming for the Day Care treatment and not an OPD treatment and then let your health plan do the rest.

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