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Day Care Expenses Versus Outpatient Expenses

Updated On Feb 15, 2021

Daycare treatments refer to treatments administered within 24 hours in a hospital under local/general anesthesia. Outpatient treatment is a treatment administered by a physician when the patient visits a clinic or any other consultation room.

To be able to make a health insurance claim settlement, a person must be hospitalised for at least 24 hours. But not all primary procedures entail day-long hospital visits, as technology has evolved exponentially over the last two decades. Dental surgery, eye surgery, hemodialysis, chemotherapy, and others are some of the most common procedures that are likely to be identified in daycare treatment-specific insurance plans.

Outpatient treatment is getting a procedure done without needing to be admitted. Outpatient treatment is a procedure where on the recommendation of a medical practitioner, some treatment or diagnosis of a certain type of illness is used. This includes the patient attending the clinic or any of the consulting rooms of the doctors. Diagnosis, such as lab tests and MRI scans are instances of outpatient treatment.

Day Care Expenses Versus Outpatient Expenses

Daycare Expenses Versus Outpatient Expenses

The treatment period in several systems has been shortened owing to technological developments in the field of medicine. This has made different medical expenses for a claim inadmissible. This is the main reason that several health insurers have introduced daycare and outpatient treatment coverage.

There is a slight distinction between what qualifies as a medication for daycare and OPD treatment. Therefore, different health insurers explicitly state the distinction. Let us see the major differences between daycare treatment and outpatient treatment in detail.

Particulars Daycare Treatment Expenses Outpatient Expenses
Hospitalisation Daycare treatments may not require 24-hour hospitalisation, but they involve at least some level of hospitalisation. For example, cataract surgery You simply visit a qualified doctor for outpatient treatment and get treated/diagnosed for a particular illness. For example, cataract surgery may count as a daycare treatment, however, cataract diagnosis qualifies as an OPD treatment.
Coverage Daycare treatment expenses are covered by all health insurance plans. Many insurers have specific guidelines about what type of daycare treatments are protected by their plans. Outpatient expenses are generally excluded from the scope of coverage of a health plan unless otherwise expressed. The coverage is generally available as an add-on cover.
Claim Process In most cases, the policyholder schedules daycare treatments in advance. The policyholder can contact the insurer in the event of scheduled treatment and check the likelihood of cashless treatment.

Outpatient coverage is an indemnity advantage that cannot be obtained through cashless care. The policyholder should send all necessary paperwork, including bills and pharmacy receipts, to make a claim. Without proper bills, no claims concerning outpatient care can be honoured by an insurer.

Bottom Line

The most popular form of health insurance is the one where patients are reimbursed for more than 24 hours of hospital admission. In addition to hospitalisation coverage, in recent years, several extensive health insurance plans have coverage for both daycare treatment and outpatient treatment. These treatments are, however, subject to the discretion of the insurer, and differ from company to company.

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Disclaimer: This article is issued in the general public interest and meant for general information purposes only. Readers are advised not to rely on the contents of the article as conclusive in nature and should research further or consult an expert in this regard.

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