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Health Insurance

Pre & Post Hospitalisation

We all talk about health insurance plans and how they help to tackle rising medical expenses. However, few realise how the various health policies cover pre and post-hospitalisation expenses too. 

 

Before getting admitted to your choice of hospital for treatment, there are certain medical costs incurred by the policyholder. These are classified as pre-hospitalisation expenses. These may include the amount spent on various tests that are needed to diagnose the kind of disorder the incurred is suffering from before prescribing the correct nature of treatment. Such tests may include urine tests, blood tests, MRI scans, CT scans and X-rays to diagnose the exact medical condition of the insured. 

 

Post discharge from the hospital, the incurred expenses have to bear certain necessary medical costs. These are categorised as post-hospitalisation expenses. These expenses may include the amount spent on tests prescribed by the doctor or healthcare provider to ascertain the health status and recovery progress of the insured. These may include the costs of medicines, consultation fees and charges on diagnostic tests. However, insurance companies do not cover therapies like naturopathy, acupuncture, homeopathy, etc. 

 

Most insurance companies pay for the pre and post-hospitalisation expenses subject to certain conditions. The number of days of pre and post-hospitalisation cover differs from one health insurance company to the other. However, most insurance companies cover 30 days of pre-hospitalisation and 60 days of post-hospitalisation expenses. 

 

Important Considerations:

 

  • Policyholders can seek a claim for pre and post-hospitalisation claims provided that the claim for expenses towards hospitalisation is accepted by the insurance company;
  • Expenses on pre-hospitalisation must be for the same condition for the patient had been hospitalised and availed necessary treatment;
  • Costs of pre and post-hospitalisation will be allowed only for the number of days mentioned in the policy. Any expenses incurred before or beyond the time limit will not be considered by the insurance company. 

To understand the concept of pre and post-hospitalisation expenses better, let us understand the same with the help of the following example:

 

Ajay Mehrotra had been hospitalised for treatment of malaria on March 01, 2019. Before being admitted to the hospital, Ajay had been consulting various doctors and underwent diagnostic tests from February 12, 2019 to February 28, 2019 subsequent to which he was hospitalised for necessary treatment. Ajay was treated for a week after he was discharged on March 08, 2019. Post discharge, Ajay had to undergo certain tests so that doctors could monitor his health progress and prescribe medicines accordingly. The post-hospitalisation tests and medicine purchases continued for nearly 35 days. 

 

In this case, Ajay had claimed pre-hospitalisation expenses for 17 days and post-hospitalisation expenses for 35 days. He was hospitalised and treated for 8 days. Assuming that the hospital is within the network of the insurer or the insurer accepts to pay claims for expenses raised by this hospital, Ajay would be reimbursed the entire expenses incurred including the pre-hospitalisation expenses, in-treatment costs and the amount spent during the post-hospitalisation period. 

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