Pre & Post Hospitalization Expenses in Health Insurance

Pre and post-hospitalisation expenses are costs incurred by a patient before and after being discharged from a hospital.For example, if Mr Aakash develops chest pain symptoms, he might visit his family physician or a cardiologist, who might prescribe tests like an echocardiogram or ECG to diagnose the problem. If the test reports show a possible heart disease, Mr Aakash's doctor will advise him to have the required surgery and get admitted to a hospital. After successful treatment, Mr Aakash will be discharged and asked to go on medication, attend a follow-up, and get more tests done.Let's suppose Mr Aakash has health insurance coverage. His policy will cover the hospitalisation and surgery expenses and expenses incurred from doctor’s fees and tests 30 days before admission. These are called pre-hospitalisation expenses. The policy will also cover doctor’s fees and investigations up to 30-60 days after his discharge from the hospital. These are termed post-hospitalisation expenses.Also read: What Is Health Insurance – Types, Features & Benefits

As the name suggests, pre-hospitalisation means expenses that arise for treating the illness or disease before a person is hospitalised. These include:1. Vaccinations2. Pharmacy Costs3. Diagnostic Costs4. Doctor's Consultation ChargesPre-hospitalisation expenses are covered only if the policyholder is eventually hospitalised. After investigations and doctor consultations, pre-hospitalisation expenses cannot be claimed if the patient is not hospitalised and just sent home.

Getting hospitalised is mandatory to claim post-hospitalisation coverage. Post-hospitalisation, including expenses incurred after being hospitalised, is considered. These would include medicines, doctor’s fees, tests, and physiotherapy.

1. Understand your policy:

Familiarise yourself with your health insurance policy. Review the terms and conditions of pre and post-hospitalisation coverage, including the waiting period, coverage limits, and necessary documents.

2. Notify the insurance company:

Inform your insurance provider when you are admitted to the hospital or receive medical treatment. Many policies require notification within a specific timeframe to initiate the claims process.

3. Collect required documents:

Gather all relevant documents, including medical bills, prescriptions, discharge summaries, diagnostic reports, and receipts for pre and post-hospitalisation expenses.

4. Fill claim form:

Complete the insurance claim form provided by your insurer. Ensure accurate and detailed information, including the nature of the illness, treatment received, and itemised bills.

5. Provide supporting documents:

Attach all necessary documents to the claim form. This may include medical reports, prescriptions, hospital discharge summaries, diagnostic reports, and original bills.

6. Submit the Claim:

Send the completed claim form and supporting documents to the insurance company through designated channels, such as email, online portals, or physical submission.

7. Await processing:

Once the claim is submitted, the insurance company will review the documents and verify the details. This may involve communication with the hospital or healthcare provider.

8. Reimbursement or direct settlement:

Depending on your policy and the insurance company's procedures, you may receive reimbursement for the approved expenses, or the insurer may directly settle the bills with the hospital and medical providers.

9. Maintain communication:

Stay in touch with the insurance company's claims department. In case of any discrepancies or additional information required, respond promptly to ensure a smooth claims process.

10. Keep Copies:

Maintain copies of all submitted documents, correspondence, and communication related to your claim.Remember, the process for claiming pre and post-hospitalisation expenses can vary based on your insurance policy and the provider's rules. It's essential to carefully review your policy documents and contact your insurance company for guidance on the correct procedure to ensure successful reimbursement or settlement of expenses.

Pre and post-hospitalisation provide many benefits that include:

1. A lesser financial burden on the patient and family.
2. Allowing the patient to focus on recovery and treatment without worrying about bills and expenses.
3. Availing the best healthcare without having to dive too deep into savings.

Also read: What Is A Pre-Existing Disease Cover?

This is when you get insurance coverage for all expenses incurred before being hospitalised, generally 30 days before being admitted. However, it may also depend on the terms of the individual policy. Speak to your insurer, and clear any ambiguity regarding this.

The period for which these expenses are covered will depend on the policy terms. Usually, it is anywhere between 30-90 days. You will get 45-90 days to submit all the relevant documents to file the claim.

Your health insurance policy will generally provide maternity coverage. The number of days of coverage for pre and post-hospitalisation depends on the terms and conditions of the policy. It is best to speak to your insurer for all details.Also read: All You Need To Know About Pregnancy Insurance Coverage

Any test, medicine, or doctor’s consultation that has no relation to the ailment for which a person is hospitalised does not qualify to be covered under pre or post-hospitalisation expenses.

It covers a broader range of healthcare costs, such as medical costs, diagnostic tests, and post-hospitalisation care.

1. It is genuinely end-to-end insurance providing more than just hospitalisation coverage.
2. It helps you live a worry-free life as you can focus on the treatment thoroughly and not worry about the expenses made before or after being hospitalised.

A health insurance policy has a broader application than many believe. Pre and post-hospitalisation coverage is essential when choosing a policy because of ever-increasing medical costs. You’d want a policy covering all the expenses incurred before or after admission. It will ensure that most of your health expenses are covered, and you do not have to shell out your money for expensive consultation fees, diagnoses, tests, and other medical expenses.