Health Insurance Coverage for Home Health Care Services
Published On Aug 06, 2019 5:30 AM By Rupanjali Mitra Basu
Today, with the increasing number of health disorders and inflating prices of medical facilities; it can be a critical situation for an individual and his family is affected by an unprecedented medical emergency. In case of such an unfortunate emergency, with the inflating prices of medical facilities; you might face a financial crisis as well. So, purchasing health insurance along with all adequate covers has become a necessity today.
In simple words, health insurance policy is guaranteed by an insurance provider to reimburse the expenditure incurred in case of an illness or accident of the insured person. To obtain this coverage, the insured person or policyholder has to pay a premium to the insurance provider.
Out of the various coverage and benefits provided by the health insurance policy, the significant benefits are the coverage provided for pre-hospitalization expenses and post-hospitalization expenses.
Pre-hospitalization is the period before the actual hospitalization of the patient. During this period, there would have been specific medical tests and medications. These tests and medications can be carried out at home without hospitalization, and the expenses are covered under the health insurance policy. Similarly, after the discharge of the patient from the hospital; there can be certain follow-up treatments or medical tests which need to be done.
This course of treatments or medications involved in pre-hospitalization and post-hospitalization can be rendered at home and are known as home health care services. Usually, the expenditure incurred for this home health care services are covered under your general health insurance policy if you have opted for this. Mostly, this coverage is provided for those treatments which are recommended or prescribed by the concerned doctor.
Benefits of Home Health Care Services Coverage
There are some major benefits which can be availed by including the home health care services into your health insurance policy.
1. The primary benefit of opting for including a home health care coverage in your health insurance policy is the quicker recovery of the patient. The post-operative treatment which needs to done for the faster recovery of the patient can start instantly if your health insurance policy covers this post-hospitalization expense. This will reduce the recovery period of the patient, which is a good sign of recuperation.
2. Moreover, these post-operative treatments or medications tend to be quite expensive. If a policyholder has not opted for these home-based treatments; then it might be a situation of financial stress for the individual and his family as well.
3. The inclusion of home health care services in the general health insurance policy is economical and affordable for the policyholder. It is economical because by opting for this home health care services; the policyholder will avoid paying room rents in the hospital. Room rents are quite expensive and can increase your total treatment cost by around 20%-30%. So, by including these services in the general health insurance policy; the policyholder lowers down his total treatment cost.
4. Home health service coverage is easily affordable by a common man as they do not lead to a significant increase in the premium to be paid. Rather, this post-hospitalization coverage or home health service cover is an essential feature which is generally included in most of the health insurance policies.
5. Furthermore, by rendering home health services, you are providing a peaceful and homely environment, which is extremely necessary for the patient’s recovery.
It is a general choice among patients to stay at home and undergo treatment rather than staying at the hospital. In many cases, it is also seen that the patient’s recovery is faster if the patient stays at his home amongst his family members in comparison to those staying at hospitals.
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What is covered under Home Health Services?
If an individual is interested or is willing to avail the home health services or the post-hospitalization services; then the individual must have to undergo hospitalization. All of the expenditures that are relevant for the illness or ailment for which the person was hospitalized will be cleared off by the insurance provider. Home health services which have been rendered for medical tests such as blood tests, x-ray, urine tests, specialist consultation fees, medication fees, etc. will be covered in the health insurance policy.
The treatments or services included under Home health services and are being covered under a general health insurance policy can be classified into below-mentioned categories.
1. Domiciliary Treatment
Domiciliary treatment consists of those treatments which are carried at home itself. This might occur due to two major reasons, i.e. either the patient is in a very critical situation and cannot be transferred to the hospital, or there is a lack of accommodation in the hospital temporarily. So, in these two cases, a patient can be provided with domiciliary treatment, and this treatment is covered in the health insurance policy.
2. Outpatient Department Treatments (OPD)
OPD treatments, i.e. Outpatient Department treatment, deals with treatments that include minor medical procedures and can be carried out in the home of the patient itself. The expenditure incurred during these treatments is generally covered in the health insurance policy. Regular doctor consultations, tests to be done by pathologists, dental procedures, treatments related to physiotherapies, etc. qualify for OPD treatments.
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3. Day Care Treatment
Day Care Treatments can also be included under the Home health services and are those procedures which are costlier in nature. These treatments do not require hospitalization of 24 hours and can be rendered at the home of the patient even. Some of the treatments which are included under day care procedures are Cataract, Chemotherapy, Radiotherapy, Hydrocele, Plastic Surgery, etc.
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4. Pre-hospitalization and Post-hospitalization
Furthermore, as said earlier, pre-hospitalisation and post-hospitalisation procedures are included in Home health services and are included in the coverage provided by a general health insurance policy.
What is not covered under Home Health Services?
Any form of medication which is being taken by the patient but is not related to the disease for which the patient has been hospitalized or for which any such medical procedure has not been prescribed cannot be included under Home health services coverage.
Moreover, other expenditure which has been incurred for some alternative treatments like acupuncture, acupressure, naturopathy, etc. cannot be included under the coverage for Home health services.
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Factors to consider while opting for Home Health Services
There are some important factors which a policyholder should consider before finalizing the decision of choosing for Home Health Services.
1. It is essential that you find out well-trained professionals and excellent quality medical equipment in order to carry out the medical procedures at home. Since this is related to the health and recovery of the patient, utmost care needs to be taken in case of the quality of the treatment that is being rendered at home.
2. Moreover, before you decide to opt for home health services, it is quite necessary that you have a brief discussion with the insurance provider on the coverage provided by the insurance provider for your chosen treatment and the exclusions related to the policy, etc. This will minimize the probabilities of any confusion and misinterpretations in future.
3. Home Health Care Services has been quite a popular trend in foreign countries like the USA, Germany, Denmark, etc. The services provided and the coverage by health insurance providers has made it all easy for this service to continue abroad. In India, the trend of home health care services is setting its feet and is gradually becoming popular among people.
Hence, you can opt for home health services for reducing some of your financial burden and speedy recovery, but it has to be done after proper research and discussion with the insurance provider regarding the coverage being provided.
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