Whenever someone close has to go through a medical emergency, a million thoughts run through our minds—the medical bills, the hospitalisation, the insurance, the claims, the reimbursements and so on. Reviewing some key terms and having certain crucial forms close at hand will help minimise the anxiety associated with hospitalisation when it is necessary. However, it would help if you remembered that the bills do not necessarily stop at hospitalisation. There are nuances like pre-hospitalisation and post-hospitalisation, which you need to familiarise with beforehand. A good health insurance plan usually takes care of such treatments and expenses. Yes, the policy is not limited to your hospital bed alone.
What are Pre-hospitalisation and Post-hospitalisation?
Health insurance policies with pre-hospitalisation and post-hospitalisation coverage pay for costs before and after the insured patient is admitted to a hospital. A health insurance plan with such a cover is considered comprehensive because it includes a limited number of pre and post-hospitalisation expenses and those incurred while in the hospital. You can use it to pay for medical test costs, ambulance bills, consultation fees for doctors, and other such expenses.
Pre-hospitalisation charges are medical costs incurred by the insured before hospital admission. An ailment may not always require hospitalisation immediately. There is a preliminary round of treatment and testing for every sickness. However, most people only file a claim for health insurance when they or a loved one needs hospitalisation.
The doctor could recommend specific examinations and scans to arrive at a precise diagnosis. And the patient gets admitted to the hospital only if the diagnosis is serious. These tests, which reveal the patient's medical status, include X-rays, CT scans, MRIs, angiographies, blood-sugar tests, and others. Pre-hospitalisation insurance will pay for these costs following the terms and circumstances of the plan. Insurance typically pays for 30 days' worth of expenses before hospitalisation. You can also extend your pre-hospitalisation coverage by up to 90 days with some of the better health insurance companies and their plans. Remember that these expenses are covered for the same disease/illness for which the policyholder requires hospitalisation.
Post-hospitalisation expenses are those incurred (to treat the patient) following the patient's release from the hospital. Costs do not stop after being discharged from the hospital. One needs to follow a significant deal of care and various procedures. To assess the status of the patient's recovery, doctors may recommend tests, and medicine must be taken as directed. These are just two of the probable post-discharge fees! Frequently scheduled medical consultations with professionals may also be necessary during this recuperation period. This is when a policy that covers post-hospitalisation costs can be helpful. Similar to pre-hospitalisation, the insurance company determines how many days are covered. Most health insurance plans pay for these expenses 45 to 90 days after hospital discharge. Some of the top insurance companies and their plans pay for these costs up to 180 days after release.
How Do Pre and Post-hospitalisation Procedures Work?
In health insurance, pre- and post-hospitalisation often follow a reimbursement model. As per corporate policy, medical bills for the insured's illness must be filed to the insurance provider or the designated Third-party Administrator (TPA). Following verification, the insurer will cover the relevant pre- and post-hospitalisation costs within a predetermined window of time, which may differ between insurance companies.
How to Claim/ File for Pre and Post-Hospitalisation Expenses?
When claiming pre-hospitalisation and post-hospitalisation costs, timing is critical. Insurance providers adhere to a specific timeline for handling such claims. For post-hospitalisation charges, the insured must finish the claim application and document submission process within the allotted period after receiving treatment. If not, the health insurance provider may reject the claim due to non-compliance issues. Hence as a precautionary measure, you must be aware of the deadline for filing such claims and follow it while settling a claim.
Key Documents Required while Filing a Pre or Post Hospitalisation Expense
- Hospital Bills
- Consultation Bills (if any)
- All the Prescriptions
- Medical Certificates
- Discharge Files
- Medical Bills
On submission of the documents, the claim verification/validation process begins. The insurer will determine whether the costs are for the same medical issue that led to the patient's admission or not. Health insurance companies reject the claim if the expenses do not tally or are unrelated. After verification, the provider will pay the claim amount per the policy's terms and conditions.
Advantages of Buying Health Insurance with Pre & Post Hospitalisation Coverage
Better Coverage — You can overcome any financial difficulties that may develop from the time the condition is diagnosed until you recover with a health insurance plan that includes pre- and post-hospitalisation coverage.
Inclusive of Treatment Costs — Surgery, dialysis, day-care treatment, and other types of treatment are frequently covered by post-hospitalisation insurance, thus easing the financial load.
Convenience of Network Hospitals — With this coverage, you can choose a hospital in your neighbourhood and quickly resolve your claim.
The cost of healthcare today might be high. It may deplete your savings and cause you to have restless nights. Hence, It is advisable to inquire with your insurance company whether pre and post-hospitalisation are also covered.
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