Inpatient vs Outpatient Hospitalization

Health insurance plans often talk about two types of hospitalization – inpatient and outpatient. While most plans offer coverage for inpatient hospitalization only, a lot of them also cover the medical expenses incurred on outpatient hospitalization. If you are confused between inpatient hospitalization and outpatient hospitalization meaning, read on to understand the differences.

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      What is Inpatient Hospitalization?

      Inpatient hospitalization occurs when a patient is admitted to a hospital for medical treatment. Usually, it involves an overnight stay at the hospital for in-depth monitoring and observation. Inpatient hospitalization is usually required during a medical emergency or for a pre-planned surgery or treatment, such as severe burns, traumatic injury, childbirth, chronic diseases, etc.

      All health insurance plans cover inpatient treatment if the patient has been admitted to the hospital for at least 24 hours. However, the extent of coverage offered by insurance companies is limited to inpatient hospitalization expenses incurred on:

      • Doctor’s fee
      • Room rent
      • Medicines and drugs
      • Intravenous fluids, injection and blood transfusion charges
      • Diagnostic tests
      • Consumables
      • Operation theatre charges
      • Intensive Care Unit (ICU) charges
      • Prosthetics and other equipment/devices implanted internally during a surgery

      Let’s understand this with the help of an example.

      Suppose Ram has been diagnosed with 90% blockage in his heart and requires major open heart surgery to clear the arteries. The doctor asked him to get hospitalized immediately and operated on him. He was kept in the ICU under constant observation for 2 days and was discharged after a week. In this case, Ram’s hospitalization is categorized as in-patient and therefore, his insurance company will pay for his hospital bills.

      People also read: Can Health Insurance be Claimed in Less than 24 Hours?

      What is Outpatient Hospitalization?

      Outpatient hospitalization occurs when a patient receives medical treatment without getting admitted to a hospital. These treatments are conducted in the outpatient department of a hospital, a clinic or a diagnostic centre.

      A health insurance policy covers outpatient treatment expenses only if it comes with the OPD benefit. While some plans may have an in-built OPD cover, others may offer it as an add-on benefit. As part of the OPD benefit, the insurance company will pay for the outpatient medical expenses incurred on:

      • Doctor consultations
      • Diagnostic tests, such as X-rays, blood tests, CT scans, MRI, etc.
      • Dental procedures and surgeries, such as cavity removal, root canal treatment, tooth extraction, etc.
      • Minor surgeries that do not require overnight observation
      • Chemotherapy, dialysis and other treatments for long-term diseases
      • Medicines
      • Rehabilitation

      Let’s understand this with the help of an example.

      Suppose Pooja developed a fever with a cold and went to a nearby clinic. The doctor diagnosed viral fever, prescribed some medicines to her and advised her to take rest. In this case, Pooja’s doctor consultation and medicine bills will be categorized as outpatient treatment and will be covered by her insurer under the OPD cover.

      People also read: What is the Difference Between Day Care Treatment and OPD Treatment?

      Difference Between Inpatient and Outpatient Hospitalization

      Take a look at the main differences between inpatient and outpatient hospitalization in the following table:

      Categories Inpatient Hospitalization Outpatient Hospitalization
      Meaning When a patient is admitted to a hospital (for at least 24 hours) for medical treatment When a patient receives medical treatment from a health professional without getting admitted to a hospital
      Medical Care Requires long-term medical care, like complex surgery cases Requires short-term medical care, like diagnostic tests
      Monitoring and Observation Requires constant monitoring and in-depth observation Does not require constant monitoring and in-depth observation
      Treatment Cost Inpatient hospitalization costs are much higher than outpatient care Outpatient treatment costs are way lower than inpatient hospitalization
      Health Insurance Coverage Covered if the hospital admission is for a minimum of 24 hours Covered if the policy offers OPD benefit
      Healthcare Professionals Requires specialists and a group of medical professionals Requires a general physician and medical specialists

      Summing It Up

      Inpatient and outpatient hospitalization are major ways of obtaining medical treatment. While one requires you to get admitted to a hospital, the other requires brief medical attention from a qualified health professional. Now that you are clear with the meaning of inpatient hospitalization and outpatient treatment, you know when to raise a health insurance claim with your insurance provider.

      Do not forget to read your health policy terms and conditions carefully to know what you are covered for.

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