Demystifying Pre and Post-Hospitalisation Expenses in Health Insurance Plans

  • postauthorOnsurity Editorial
  • postdateJanuary 30, 2024
  • postreadtime4 min read
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Sarah is a 35-year-old woman with a comprehensive health insurance plan. Her frequent job-related travels often lead her to dine out for most of her meals. On one fateful day, she starts to endure excruciating abdominal discomfort. Sarah visits her primary care physician, who refers her to a specialist for further evaluation. The specialist suggests various tests, including blood tests and an ultrasound to confirm the diagnosis and assess the severity of the condition. Sarah is prescribed pain relief and antibiotics to prepare her for surgery. Sarah is admitted to the hospital for an appendectomy. After a successful surgery, she is discharged from the hospital. To aid her recovery, the doctor prescribes her pain killers and antibiotics.

Sarah must visit her surgeon for post-operative check-ups to ensure her incision is healing well and there are no complications. Although Sarah initially had concerns about the expenses, her health insurance plan came to her aid by providing coverage for both pre and post-hospitalization expenses. This prevented her from bearing the financial strain that she would have had to endure had her health insurance plan not provided comprehensive health insurance coverage.

Pre and post-hospitalization expenses explained

What are pre-hospitalization expenses?

When an illness strikes, the first step is consulting a doctor who deciphers your symptoms. Should things take a serious turn, the doctor might call for diagnostic tests and prescribe antibiotics. If results reveal a severe issue, hospitalisation could be necessary.

Pre-hospitalization expenses refer to medical costs incurred before a patient is hospitalised. These costs can include doctor’s consultations, diagnostic tests, medicines, or services received in the period leading up to the hospitalisation.

Pre-hospitalization expenses are usually covered for a period of 30-60 days which may vary from insurer to insurer.

What are post-hospitalization expenses?

Imagine you’ve just been discharged from the hospital after a sudden illness or a surgical procedure. While you’re relieved to be on the path to recovery, your journey to full health may not be over yet. In the days and weeks following your hospital stay, you might need to continue seeing your healthcare provider for follow-up appointments, physical therapy sessions, or continue with the prescribed medications. This can indeed cause a lot of financial burden. To help you cater to such expenses after your hospitalization, insurers cover the cost of post hospitalization expenses as well.

These expenses encompass medical costs incurred after being discharged from the hospital, thus providing financial support and ensuring that you can access the necessary care without worrying about the cost.

Post hospitalization charges are usually covered for a period of 30-60 days.

How do pre and post-hospitalization expenses help?

Extensive Coverage: By having a health insurance plan that includes both pre and post-hospitalization expenses, you secure comprehensive coverage, guaranteeing financial protection not only during your hospital stay but also before and after it.

Financial protection: You can land in financial trouble if you don’t have enough savings to cater to your pre and post hospitalization expenses. A Health insurance plan that covers these costs can ease your financial burden, covering a significant portion of these costs.

Encouraging Timely Medical Care: When you know that your insurance covers pre-hospitalization expenses, you’re more likely to seek timely medical attention when needed, reducing the risk of your condition worsening.

Post-Discharge Support: Post-hospitalization expenses can include rehabilitation and follow-up visits, which are crucial for a full recovery. A Health insurance plan ensures you can access the necessary care without worrying about the cost.

Claim process for pre and post-hospitalization expenses

Review the policy: Before registering your claim for pre and post-hospitalization expenses, review your policy to check on the coverage offered for the same. Check the number of days for which these expenses are covered. Few policies cover pre and post hospitalization expenses for 30-90 days, whereas few cover the same for 60-120 days. Note that a few policies also cover this expense as in the form of percentage of the sum insured or the hospital bill.

Notify your insurer: Inform your insurer about the expenses incurred. Also, ensure that these expenses are claimed towards the same condition for which you are hospitalized. It’s advisable to notify your insurer at the earliest possible.

Submit the required documents: Submit relevant documents including claim form, medical bills, diagnostic test reports, prescriptions, discharge summary, etc.

Review and processing: Upon receiving your claim and supporting documents, the insurer will do a thorough review. The claim will then be proceeded for reimbursement as per the policy terms and conditions.

Pre and post-hospitalization expenses are essential components of a health insurance plan. They provide comprehensive protection, ensuring that your financial well-being is safeguarded not just during your hospital stay, but throughout your entire healthcare journey. To make the most of your health insurance, it’s crucial to understand the terms and conditions of your policy and be aware of the coverage it provides for these expenses. By doing so, you can enjoy peace of mind knowing that you’re prepared for any medical situation that may arise.

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