Health Insurance November 28, 2020

What is a Day Care Procedure in Health Insurance?

In today’s times, Health Insurance is not an option anymore, instead, people have started to consider it as a need knowing a disease often comes uninformed. But there are a few technical things that people are often confused about. One such thing is people like to believe that a health insurance policy does not provide the cover for treatments if they would be discharged from the hospital within 24 hours. Such people don’t know anything about a Day Care Procedure in a Health Insurance Policy.

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Are you also one of those who fear that if you get hospitalized for less than 24 hours, you would not get the cover for such treatments? Well, there is not such a thing. With the advancement of medical technology, treatments that used to take days before can be done in a few hours. Such treatments are called Day Care Procedures. When a patient undergoes any of the day care procedures, s/he gets discharged on the same day.

So, what are the common day care treatments? In this article, we will talk about the same. We will also discuss some of the important aspects of Day Care Procedure in Health Insurance Policies. So, keep reading!

What Qualifies as a Day Care Procedure?

As we said earlier treatments that usually take less than 24 hours of Hospitalization are qualified as Day Care procedures. Suppose an individual needs to undergo a Cataract surgery for the replacement of his eye lens. Due to medical technology advancement, cataract surgery takes a few hours, and he would get discharged on the same day. So, would he be able to get claims for this treatment?

The answer to this question is YES! With the inclusion of Day Care Procedure in a Health Insurance Policy, individuals can get claims for all day care treatments that require hospitalization of less than 24 hours. Treatments for which individuals need over 24 hours of Hospitalization get coverage under ‘In-hospitalization Expenses’ in your policy.

Now, you must be thinking what are those treatments that come under a Day Care Treatment? Well, you need to understand that not every day care procedure comes under a policy. It may vary from one health insurance policy to another. That’s why you should always go through your policy documents before choosing a plan. We are showing treatments that usually fall within the scope of a Day Care Procedure. Please check!

  1. Bone fracture and joint-related surgeries
  2. Colonoscopy
  3. Nasal Sinus Aspiration
  4. Hydrocele
  5. Liver Aspiration
  6. Eye Surgery such as Cataract surgery
  7. Radiotherapy and Chemotherapy
  8. Coronary Angiography
  9. Tonsillectomy
  10. Sclerotherapy
  11. Certain injury-related Dental Surgeries
  12. Removal of a Foreign Body from the Nose

These are some of the Day Care procedures that an insurance policy comes with. In the policy document, you will get a complete list of covered day care procedures.

Important Aspects

Now you have a basic idea about what exactly a Day Care procedure is, you should know some of its important aspects. We are mentioning them below. Please look!

  1. The first thing you need to know is that the Outpatient Department (OPD) Treatments and Day Care procedures are not at all the same. Treatments for which you don’t need any hospitalization are known as OPD Treatments. For such treatments or diagnoses, people only need to visit the clinic of a Medical Practitioner or Doctor. For example, a regular dental cleanup would come under an OPD Treatment, while a Dental Surgery would come under a Day Care Procedure. So, there is a fine difference separating the two.
  2. Another important aspect of a Day Care procedure is the Coverage Availability in your Health Insurance Plan. A Day Care procedure is considered to be one of the standard features across all health insurance plans. So, you can find the facility of day care treatments in almost all plans, whether they are individual plans or comprehensive family plans.
  3. A Day Care procedure not only covers expenses on operation or surgery but also different expenses such as Diagnostics, Medications, Hospital Admissions, Vitals, Injections, and post-hospitalization expenses. This is why, when you have a Health Insurance Policy, Day Care procedures help people in coverage of such expenses.
  4. There is one common thing that many people want to know about — ‘How much a Day Care Procedure will cover?’ The best thing about day care procedures is there are no limits within your sum insured limit. Your Health Insurance Plan covers most day care treatments (except a few treatments) up to the sum insured limit. This limit may vary from one individual to another according to the policy.
  5. The most important aspect of the Day Care Procedure is the Claim Settlement process, and you should know the individuals can get a claim for a Day care procedure in the same way for regular Hospitalization. The best thing about a Day Care Procedure is the freedom to choose from two options to settle claims — The cashless Method and the Reimbursement method. People usually pre-plan their day care procedures. This is the reason people can get admission to a network hospital (decided by your Insurance Company) and enjoy the benefits of the Cashless method. Just intimate your Third-party administrator (TPA) about the admission to the hospital. People can also choose a reimbursement method, in case they are being admitted to a Non-network hospital. After getting discharged, submit a few documents and you will get the settlement amount.

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