difference between outpatient and inpatient insurance

What is the difference between outpatient and inpatient insurance?

One of the most popular questions that we are asked when our customers want to purchase a health insurance policy is “What is the difference between outpatient and inpatient insurance?” 

Some people might get confused with how the two words “outpatient” and “inpatient” differ. Therefore, in this article, we provide you with an in-depth explanation about the difference between the two terms both in the healthcare and health insurance context.  

Outpatient and Inpatient in the context of healthcare 

What is outpatient care? 

Also known as ambulatory care, outpatient care is a type of healthcare in which you do not need to stay overnight at a hospital or under medical care beyond 24 hours.  

An example of outpatient care include daycare treatment or day surgeries in which you have an operation in the morning and are allowed to go home in the afternoon for recovery.  

Another example is a clinic visit in which your doctor diagnoses you and treats you accordingly and then you can return home. Typically, the majority of outpatient clinics are not located in hospitals. They are either standalone or in an office building. 

You become a clinic or hospital outpatient upon your first arrival at the medical facility. If another physician refers you or admits you, then you are considered a hospital inpatient. 

Generally speaking, outpatient care costs less than inpatient care due to being a less time-consuming process and less usage of complicated medical amenities.   

What is inpatient care? 

Inpatient care is a type of healthcare in which you need to be admitted to the hospital normally overnight or beyond. This means that nurses and physicians will supervise you until you are in good health again and in a position where you can return home conveniently. Typically, clinics and medical providers at office towers do not offer inpatient services. 

An example of inpatient care is surgery where you have to stay at a hospital overnight. This type of medical care costs more than outpatient care because of costly medical tests, monitoring, the provision of a hospital bed and meals. 

Outpatient and Inpatient in the context of health insurance 

What are outpatient benefits on a health insurance plan? 

Simply put, outpatient benefits cover medical costs in which you are not hospitalized (receiving only ambulatory treatment) and do not need to stay in the hospital for a certain period of time (typically more than 24 hours). 

For example, let’s say you break your leg and need to be treated in an emergency room (ER). However, you are not admitted there beyond 24 hours, your health insurance provider might consider this as outpatient care. In this case, your medical expenses will only be covered as long as you have an outpatient insurance plan with you.  

To make sure whether your health insurer is going to provide coverage for your medical costs or not, you are recommended to go through the X-ray or advanced imagery benefits of your health insurance plan. You can find this in the document you received when you purchased your health insurance plan in the beginning. 

The benefits of outpatient care on your health insurance plan can cover the following items: 

• Alternative therapies (for example, Traditional Chinese Medicine (TCM) 

• Diagnostic tests (for example, X-rays) 

• General practitioner costs 

• Prescribed medication 

• Scheduled medical check-ups 

• Specialist costs 

• Vaccinations 

Note: Do keep in mind that your health insurer might not provide coverage for all areas of an alternative therapy. Therefore, you need to carefully check the terms and conditions of your benefits all the time.  

What are inpatient benefits on a health insurance plan? 

Inpatient benefits basically cover medical costs that are related to your hospital admission usually for at least 24 hours. Your hospitalization might involve major surgeries and terrible accidents.  

Inpatient-only health insurance plans typically do not provide coverage for medical costs that are incurred before or after your surgery. This means that only the costs of surgery are covered. 

The benefits of inpatient care on your health insurance plan can cover the following items: 

• Ambulance transport expenses 

• Diagnostic tests (for example, X-Rays, CAT & PET scans, including laboratory tests) 

• Inpatient medicines that are given during hospital admission (inpatient medicine) 

• Intensive care rooms (ICU) 

• Medical fees including nurse and doctor 

• Organ transplants 

• Semi-private or private hospital room during surgery 

• Surgical appliances and prosthetic device expenses 

• Surgical, anesthetic, operating room fees 

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