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What are Pre-Post Hospitalization Expenses in Health Insurance?
What if I told you that your health insurance also covers your medical tests, doctor consultations, and follow-up care? Amazing, right? 🤩
Most people think health insurance only covers hospital bills, but the real game-changer is that it covers pre and post-hospitalization expenses too.
From diagnosis to recovery, your insurance has your back, ensuring you’re financially protected every step of the way. Let’s dive into what these crucial benefits mean, how they can lighten your medical expenses and what they cover.
Table of Contents
What are Pre-Hospitalization Expenses?
These are any medical expenses incurred before being admitted to a hospital. They include the medical tests conducted to reach a diagnosis before admitting a patient to the hospital for treatment.
Generally, such expenses are covered up to 30 days before the date of hospitalization, but this can vary from insurer to insurer.
Expenses covered under Pre-Hospitalization
Pre-hospitalization expenses include:
- Doctors Consultation
- Diagnosis tests such as X-rays, CT scans, MRIs
- Physical examination such as blood tests
- Cost of Medication
- Specific Vaccinations
What are Post-Hospitalization Expenses?
Treatment and recovery usually do not usually end immediately after leaving the hospital. Post-hospitalization expenses are costs incurred after the patient is discharged from the hospital.
Usually, health insurance policies cover medical costs incurred between 45 and 90 days after hospital discharge, and these costs vary from policy to policy.
Expenses covered under Post-Hospitalization
Post-hospitalization expenses include:
- Follow up care
- Medical consultation
- Post-surgery diagnostic tests
- Medication
Pre and Post Hospitalization Expenses Simplified
What if we tell you that the expenses incurred before and after hospitalization are also covered?
Well, yes! From initial tests and consultation to follow-up care and medication, everything is covered pre and post-hospitalization so that you can manage your medical expenses. Watch the video to know the coverage and duration of pre and post-hospitalization.
Importance of Pre and Post-Hospitalization Coverage in Health Insurance
When you have health insurance that covers pre and post-hospitalization expenses, there are a number of benefits, such as:
Less Financial Burden
Having these extra expenses covered will help to reduce your financial burden.
Reduced Stress
When you have this coverage, you can focus on your treatment and recovery without worrying too much about your medical expenses.
More Prepared for Medical Emergencies
In case of any unexpected medical emergency, even after hospitalization, you will be more prepared.
Preserve Your Savings
It will ensure that your savings are not drained while you still get the best care for your health.
Benefits of Buying Health Insurance with Pre & Post Hospitalization Coverage
Now, you must be clear on what pre and post-hospitalization expenses mean, but do you know the benefits of using this coverage in your health insurance? Here are some reasons:
Is Pre and Post-Hospitalization Coverage a Standard Benefit or an Optional Add-On in Health Insurance?
In most health insurance plans, pre and post-hospitalization cover is often included as a standard benefit, i.e., it is already included in the policy as a coverage.
However, some insurance policies do not primarily include it. In such cases, you can ask your insurance provider to add it as an add-on or rider.
Understanding whether this coverage comes by default or requires an additional premium is crucial as it ensures comprehensive protection against unexpected medical costs during hospitalization. Always read your policy document to understand about what is included in your plan.
How to Claim Pre and Post Hospitalization Expenses?
Always remember to make a claim for pre and post hospitalization expenses within the mentioned time period for each of these covers. The following steps should be considered:
Step 1
Ensure that the claims made before and after hospitalization are for treatment of the same condition for which the patient was admitted.
Step 2
Fill in the required claims form and attach your hospital bills and all relevant documents (such as confirmation of diagnosis, prescriptions, discharge summary, etc.) and share the same with your insurer and the TPA.
Step 3
Remember to submit the claim within 45-90 days of hospitalization. (Check with your insurer about the timelines for filing a claim.)
Step 4
Once the documents are submitted, the insurer will verify them.
Step 5
If they decide that the expenses were related to the same medical condition for which the patient was hospitalized, the claim will be accepted.
How Long Can You Claim Pre and Post-Hospitalisation Expenses?
When it comes to claiming pre and post-hospitalisation expenses, the time frame varies based on the specific health insurance policy. Always read your insurance policy for coverage. Here is the time duration for claiming the expenses:
Pre-Hospitalization Expenses
Hospitalization expenses incurred 30 days before the admission date are covered under these expenses.
Post-Hospitalization Expenses
Hospitalization expenses incurred 45 to 90 days after admission are covered under these expenses.
When Pre and Post-Hospitalisation Claims Are Rejected?
There are times when the claims can be rejected. Before filling out a claim under pre and post-hospitalization, there are a few things you need to remember to avoid rejection. It includes:
Time Duration
The claims can be rejected if they are made after the allotted time period, decided by you and your insurer, which is between 30 before and 90 days after being hospitalized.
False Information
The insurer will reject the claim if the bills and reports are inaccurate. It can be denied if some of the required documentation is not provided.
Fake Reports
The claim can be rejected if the diagnostic reports and expenses don't match.
How Pre and Post-Hospitalisation Expense Coverage Work in Health Insurance?
In a health insurance plan, pre and post-hospitalization benefits give the insured individual comprehensive coverage while suffering from any illness which requires treatment. Let’s see how it works:
If pre and post-hospitalization coverage is unavailable in your health insurance plan, you can discuss with your insurer to obtain it as an add-on coverage.
Things you Should Know about Pre & Post-hospitalization Cover
Having health insurance for pre & post-hospitalization coverage can be a blessing for you, but you must be aware of a few important things regarding this coverage. Here are some things you must remember:
- Same Medical Condition: Generally, only the illness or medical condition for which you are undergoing treatment will be covered under pre and post-hospitalization costs by your insurance provider.
- Timeframe: The expenses are only reimbursed for a predetermined period of time, typically 30 or 90 days for pre and post-hospitalization, respectively. Check for the timeframe with your insurance company.
- Hospitalization Required: The coverage for pre and post-hospitalization costs becomes active only once you are admitted to the hospital. If you were treated at home instead of a hospital, you are not eligible for reimbursement for these costs.
- Bill & Receipts Submission: When buying such coverage, make sure that you know the type of documents you need to submit to claim the expenses.
Medical bills don't come from hospital stays; they start piling up long before and can continue even after treatment. However, having pre and post-hospitalization coverage can cover everything from start to finish.