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Pre-Hospitalisation and Post-Hospitalisation Expenses in Health Insurance

Team AckoJan 17, 2024

Health insurance, is a ‘friend in need’ in case of medical emergencies. During such challenging times, a wide-ranging health insurance policy can help you to keep your savings intact by paying most of the medical bills. However, medical bills are not only restricted to hospitalisation. Medical expenses often occur pre-hospitalisation and post-hospitalisation as well. A good health insurance plan covers expenses such as pre-hospitalisation tests and post-hospitalisation treatments. Read ahead to know more about pre-hospitalisation and post-hospitalisation expenses in the health insurance sector.

Contents

What is Pre-Hospitalisation and Post-Hospitalisation Cover in Health Insurance?
What are Pre-hospitalisation Expenses?
What are Post-hospitalisation Expenses?
Benefits of Pre and Post Hospitalisation Coverage
How Does Pre-Hospitalisation and Post Hospitalisation Work?
How to Claim Pre-Hospitalisation and Post-hospitalisation Expenses?
When are pre and post hospitalisation claims not accepted?
- Things to Remember:
When are pre and post hospitalisation claims not accepted?
- Summing It Up
Frequently Asked Questions:

What is Pre-Hospitalisation and Post-Hospitalisation Cover in Health Insurance?

The pre-hospitalisation and post-hospitalisation, cover in health insurance refers to policy inclusions that cover the expenses incurred before and after the insured patient is admitted to a hospital. A health policy with such a cover is considered wide-ranging as it not only covers expenses incurred during hospitalisation but also covers select expenses incurred before being hospitalised and after being discharged.

These expenses can drain out your savings if not covered by your health insurance policy. Hence, pre-hospitalisation and post-hospitalisation coverages help to place a shield over your savings by offering financial support to settle medical bills during these difficult times.

What are Pre-hospitalisation Expenses?

Medical expenses incurred before being admitted to a hospital are considered as pre-hospitalisation expenses. Usually, when people feel uneasy, they visit their family doctor or specialist. The doctor might suggest certain tests and scans to reach a concrete diagnosis. If the diagnosis is severe, the patient is admitted to a hospital.

Generally, several medical tests are conducted before admitting a patient to the hospital. These tests include X-ray, CT scan, MRI, Angiography, Blood-Sugar test, etc. that determine the medical condition of that person. Expenses for such tests will be covered under pre-hospitalisation cover as per the terms and conditions of the plan.

Most insurance companies offer pre-hospitalisation coverage for up to 30 days prior to the date of hospitalisation. However, this period may vary from one insurer to another. Please note that pre-hospitalisation expenses are covered for the same illness for which the insured is admitted in the hospital.

What are Post-hospitalisation Expenses?

Expenses incurred (to treat the patient) after being discharged from a hospital are considered as post-hospitalisation expenses. In cases involving hospitalisation, treatment does not usually end immediately after a patient is discharged from the hospital.

Post-discharge recovery includes medications and care. Frequent medical consultation sessions with experts can also be a part of this recovery process. This is where a cover including post-hospitalisation expenses can be helpful.

Post-hospitalisation covers the medical expenses incurred for the follow-up treatment for which the patient was hospitalised. Most health insurance policies cover these costs between 45-90 days post the discharge date from the hospital.

Benefits of Pre and Post Hospitalisation Coverage

Here are the top reasons to buy medical insurance with pre-hospitalisation and post-hospitalisation coverage.

1) Superior Coverage:

A health insurance policy with a pre-hospitalisation and post-hospitalisation coverage will help you tackle the financial challenges that may arise right from diagnosing the disease till recovery. All health insurance plans might not offer such coverage. Thus, it becomes imperative to read through policy inclusions and exclusions to know more about the coverage before buying the plan.

2) Includes Treatment Cost:

Sometimes, the post-hospitalisation treatment cost of a disease can be more financially draining than initial hospitalisation. For example, a person might be hospitalised for a disease for a week, but regular post-discharge treatment might run for months. Post-hospitalisation insurance usually covers the treatment cost for surgeries, dialysis, day-care treatment, etc. thereby reducing the financial burden.

3) The Convenience of Network Hospitals:

Insurance companies provide a list of hospitals for your treatment. Here, you have the liberty to choose your preferred hospital from the list as per your convenience. With this cover, you can choose a hospital in your locality and settle your claim in a hassle-free manner.

How Does Pre-Hospitalisation and Post Hospitalisation Work?

Pre-hospitalisation and post-hospitalisation in health insurance usually work on a reimbursement model. Here’s an example.

10th January – Patient approaches doctor and the doctor suggests some tests (pre-hospitalisation expense)
12th January – Doctor examines the test results (pre-hospitalisation expense)
13th January – Patient is admitted in a hospital (hospitalisation expense)
20th January – Patient undergoes treatment in the hospital and is discharged (hospitalisation expense)
25th January – Follow-up treatment (post-hospitalisation expense)
30th January – Follow-up treatment (post-hospitalisation expense)

The bills for medical expenses related to the disease for which the insured was hospitalised need to be submitted to the insurance company or the appointed Third-party Administrator (TPA) as per the company policy.

Post verification, the insurer will reimburse the applicable pre-hospitalisation and post-hospitalisation cost within a specified period, which may vary from one insurance company to another.

How to Claim Pre-Hospitalisation and Post-hospitalisation Expenses?

Timing plays a crucial role in claiming pre-hospitalisation and post-hospitalisation expenses. Insurance companies follow a strict time frame for settling such claims. For example, the claim application and document submission process for post-hospitalisation expenses need to be completed within the stipulated time of availing the treatment. Otherwise, it can be rejected on the grounds of non-compliance. Therefore, you must know the time limit for such claims and abide by it during claim settlement.

For filing a claim, you need to submit the following documents for verification:

Original hospital bills
Applicable medical certificates
Original Prescriptions
Discharge summary
Medicine and drugs bills
Other supporting documents requested by the insurance company

The claim verification/validation process begins after the documents are submitted. The insurer will check whether the expenses are related to the same medical condition for which the patient was admitted or not. Claim rejection is a likely possibility if expenses are not related. After verification, the claim amount will be compensated as per the terms and conditions of the policy.

Also, read: Pre-Policy Medical Check-Up and Tests

When are pre and post hospitalisation claims not accepted?

There are times where claims are denied. In order to avoid that situation, keep these points in mind.

Cause inconsistency:

Medical condition is not covered in the pre or post-hospitalization expenses of your insurance policy.

Lapse of time:

If the claim is raised after the acceptable period i.e after 45-90 days of hospitalisation.

Incorrect information:

If the bills and reports provided are incorrect, the insurer will not accept the claim. Claims might get rejected even if some of the mandated documents are missing.

Discrepancy in treatment:

If the reports and expenses submitted are different from the reason for in-partient admission.

Things to Remember:

Here is a list of things to be noted concerning pre-hospitalisation and post-hospitalisation expenses:

The treatment cost before and after hospitalisation should be for the same condition for which the patient was admitted.
The expenses for the post-hospitalisation claim will be considered only if they were made during a specified period (for example, 45 to 90 days). These days may differ for different insurance companies. Any expenses incurred after the mentioned time limit will not be covered by the insurer.
For filing a claim, make sure you submit all the necessary documents as requested by the insurer/TPA.

When are pre and post hospitalisation claims not accepted?

If the treatment undergone and the treatment claimed for do not match
If the claim isn’t raised within the approved time post discharge (Usually 30 days)
If all the required documents are not submitted on time

Summing It Up

Buying health insurance is the smartest thing you can do to secure your health and wealth. While choosing your health insurance provider and plan, make sure you take time to research about the offerings and choose a plan that suits your needs the best. Take care!

Frequently Asked Questions:

Here are some frequently asked questions related to the above-mentioned topic:

Q1) What is usually covered under pre-hospitalisation expenses?

A pre-hospitalisation cover usually includes the expenses incurred for the tests before the patient is admitted in the hospital. For example, the cover includes expenses for X-rays, CT scans, MRI scans, consultation fees for physicians, etc.

Q2) What is post-hospitalisation expenses coverage?

Patients often need medical care and treatment after being discharged from the hospital. Such expenses are included under post-hospitalisation coverage. The medication expenses, therapies related to the conditions, and post-discharge consultation are usually included under post-hospitalisation cover.

Q3) How do I claim pre-hospitalisation and post-hospitalisation expenses?

To file a successful claim, you need to submit the required documents and follow the claim process diligently.

Q4) Do I have to purchase pre-hospitalisation and post-hospitalisation cover separately?

In most cases, such covers are included in a wide-ranging health insurance policy and do not need to be purchased separately.

Q5) Are ayurvedic treatments covered under post-hospitalisation?

Some insurers might cover such expenses while some might not, it depends upon the chosen insurer and the policy. Please go through the inclusions and exclusions of the health insurance policy to know if ayurvedic treatments are covered under post-hospitalisation expenses or not.

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