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Are you covered for day-care?

By Jay Sampat | 6/20/2011 6:48 PM Monday

Based on past practices, people assume that only costs incurred during an elongated stay at the hospital qualify for reimbursement. This is despite the fact that insurance companies are advertising heavily as well as paying for a host of procedures where the patient is not required to spend 24 hours at a hospital, namely ‘day-care procedures’. In fact, these days several insurers make such treatments as their key selling point while advertising their portfolio. The number and type of day-care procedures covered depends on the insurance company you opt for.

While the awareness about such procedures is increasing and many insurance-seekers make it a point to scan this aspect while choosing a policy, there are many who are still unaware about the approach to follow while buying such policies. Here are a few suggestions to be considered while choosing the right policy. Advancements in medicine have resulted in many treatments that earlier necessitated hospitalisation but can now be completed within a day. Cataract, for instance, entailed more than 24 hours’ hospitalisation earlier, but is now treated in 12 hours. While the list of procedures covered under ‘day-care’ are extensive, usually treatments like cataract, tonsillectomy, dialysis, chemotherapy, etc are those that qualify as day-care procedures.

While day-care procedures do not entail 24-hour hospitalisation, this does not mean they are any less expensive. In fact, the total cost of a procedure like dialysis may well exceed the expenses incurred on say, a hernia surgery. Some people make the mistake of comparing the number of day-care procedures covered while looking for a policy. So if one company claims that it covers 150 procedures while another undertakes to pay for 140 treatments only, it does not necessarily mean that the former is offering you a better deal. The hitch, like always, lies in the detail. Some companies may promise to cover, for instance, stomach surgery, which is a broader definition of any illness related to the stomach.

On the other hand, some other company may divide this further into several ailments, thus resulting in a larger number, but with the possibility of leaving out certain treatments in the process. Public sector insurers, for example, include a broader definition even though the number of procedures covered is smaller. Now, if a new procedure for treatment comes up in the future, those owning policies with a strict definition of what is possible may stand to lose out due to the new specifics. Hence, if you are comparing two policies, go for the policy that offers a wider definition of illnesses covered.

When it comes to filing claims, there is no difference except that some insurance companies may request advance notice for planned day-care procedures. Since most day-care procedures are done on a planned basis, the approval for cashless treatment usually happens prior to admission in hospitals and, in most cases, subsequent addendums are not required. In the case of 24-hour hospitalisation claims, however, cashless approval is sought either prior to admission or while the customer is admitted and there may be subsequent addendums depending on the diagnosis and complications of treatment.

Since a lot of day-care procedures are surgical, the cost of treatment is easier to standardize and, hence, cashless approvals are quicker than for regular hospitalisation expenses. Since the assessment process is simpler, the reimbursement process is also faster. In addition to regular hospitalisation costs, most policies also cover - subject to certain parameters - expenses incurred 30 days prior to hospitalisation and 60 days post-discharge. Policies undertake to fulfill this commitment for day-care treatments as well. Therefore, any expenses incurred by the insured for medication and medical care required during the period of treatment will be reimbursed by the insurance company.

Provisions for pre and post-hospitalisation benefits do not generally change for day-care procedures. However, insurance companies may restrict the number of days for which such benefits may be offered. Both life and general insurance companies offer benefit as well as indemnity-based policies. The amount of claim that will be disbursed would also depend on whether you have opted for a benefit or an indemnity (or reimbursement) policy. If the benefit policy promises to reimburse expenses only on a per day basis, the amount is likely to be small and, thus, you could be at a disadvantage in the event of your actual expenses exceeding this limit. In this regard, indemnity-based policies score over their benefit counterparts. However, benefit policies that assign fixed reimbursement sum to specified treatments could still be worthwhile.

 

Find More Articles on: Personal Finance, Insurance, DSIJ Magazine, Insurance, General Insurance, Health Insurance

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