How does insurance cover “Day-Care” health procedures?

In recent years, modern advances in science and technology have changed the face of the Indian healthcare industry. Until a few years ago, carrying out medical procedures like eye surgery and kidney stone removal used to take some days. Today, complex treatments like these have become a lot faster and take just a few hours to complete.

However, in spite of the many scientific advances, healthcare costs have only increased. Very few people can afford treatment in case of a health emergency. For others, it’s either a huge dent in their savings or reliance on financial help from outside.

Surprisingly, most over-the-counter treatments cost almost twice as much as the cost for hospitalization! This is why most of the major health insurance providers have begun giving day-care health coverage to their customers. Day-care health insurance coverage offers the necessary financial relief by paying for costs related to medical treatments that need only short-term hospitalization and can be taken care of in less than 24 hours.

Example

Mr. Arvind holds a health insurance plan, which covers day-care health procedures. When he is diagnosed with kidney stones, his doctor advises lithotripsy (kidney stone removal surgery) as the required treatment. Incidentally, a decade ago, Mr. Arvind’s father too had suffered from kidney stones and had to be hospitalized a few days for the kidney stone removal procedure. Remembering this, Mr. Arvind worries that his surgery will not be admissible under day-care health coverage. He goes on to air his concern to the doctor. He is surprised to find, however, that due to technical advances, the surgery now lasts only a few hours and because of this, the hospital will discharge him the same day of the surgery. Therefore, Mr. Arvind, unlike his father, can make a hassle-free claim for the kidney stone removal surgery, as it is listed under day-care health procedures!

Claim process

The claim filing process for a day-care health procedure is similar to that of the claim filing process for a regular hospitalization.

You must notify the insurance company beforehand in the case of a planned procedure and within 24 hours in the case of an emergency procedure. Make sure you maintain all your medical records for the reimbursement to go smoothly.

Procedures covered

Treatments that are usually admissible as a Day-Care Health procedure include:

  • Appendectomy
  • Angiography
  • Angioplasty
  • Fracture/dislocation excluding hairline fracture
  • Surgery of ligament tear
  • Chemotherapy
  • Colonoscopy
  • Dental Surgery
  • Eye Surgery
  • Ear Surgery
  • Radiotherapy
  • Lithotripsy (kidney stone removal)
  • Incision and Drainage of abscess
  • Hydrocele
  • Hemodialysis
  • Hysterectomy
  • Hernia
  • Tonsillectomy
  • Piles / Fistula
  • Prostate
  • Sinusitis
  • Liver aspiration
  • Dialysis
  • Sclerotherapy

Checklist

There are a few things you should consider while choosing a day-care health insurance coverage.

  • Cost:

Most of health insurance plans in India today cover day-care procedures. However, the costs vary. So, don’t forget to compare the benefits before you buy a plan to ensure you get your money’s worth.

  • Broad categories:

Though it may seem like a good idea, choosing a health insurance plan that lists a large number of procedures may not necessarily be in your best interests. Instead of going for the impressive quantity of specific procedures covered, go for quality; you’d be better off choosing a coverage that mentions broader categories of day-care health procedures.

  • Out Patient Department (OPD) clause:

To save spending from your pocket on minor procedures (that last only a couple of hours and don’t require hospitalization even for a day), check if the plan you are considering offers the OPD clause. Note that most dental treatments fall under the Out-Patient-Department category, but not all health insurance plans cover OPD diagnosis and treatment.

Read more about day care treatment vs outpatient expenses

  • Treatment at home:

This option covers the cost of treatment at home, when a patient cannot be moved to a healthcare center or hospital. This benefit can literally be a lifesaver but very few health insurance plans offer it.

  • Cashless treatment option:

Cashless medical transaction is generally available at hospitals or healthcare centers that have partnered with the insurance company. In case of planned procedures, you can easily avail this option by letting your insurance company know about it well in time.

Thus, by going for a health insurance plan that covers day-care procedures, you can also protect your finances while you protect your health.Visit our site to know more about health insurance plans.

Read more about  What is insurance and how does it works?

Read more about  An anatomy of an health insurance plan

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