A detailed explanation on Pre and Post hospitalization expenses under the health insurance policy

An accident is the only healthcare emergency that happens suddenly. All other medical conditions don’t occur by chance. At first, you will experience the symptoms of the ailments, then visit doctors for consultation and diagnosis, medical tests to evaluate your condition. Finally, if needed, you might shift to a hospital. This is called the pre-hospitalization phase, and all these expenses are known as pre-hospitalization expenses.

Similarly, after getting discharged from the hospital, the patient needs to follow his/her medical treatments until he/she doesn’t feel perfectly fine. They may also need to take consultation during their recovery process. This phase is known as the post-hospitalization phase, and all the expenses related to this phase are known as post-hospitalization expenses.

Though most health insurance policies cover hospitalization expenses, some may also cover pre-and-post-hospitalization expenses. Because of healthcare inflation, these pre-and post-hospitalization expenses will certainly drain out your savings if you are not adequately covered. Thus, before opting for a health insurance policy, you should check the coverage for pre-and post-hospitalization in health insurance policies.

What is pre-hospitalization in health insurance?

Pre-hospitalization expenses mean various charges related to healthcare tests done before an individual gets hospitalized. A professional healthcare doctor will conduct a series of tests to properly diagnose the patient’s medical condition before suggesting a treatment method. The number of days that are covered under this pre-hospitalization expense policy varies from insurer to insurer. But most health insurance policies cover charges incurred by an individual 30 days before his/her admission to any hospital. Several tests, including blood tests, urine tests, and X-RAYs, are covered under pre-hospitalization expenses.

Some insurance companies also offer coverage for up to 60 days. But you must note that pre-hospitalization expenses are covered only for the same condition for which the insured policyholder needs to hospitalize.

Considering the COVID-19 treatment procedure, all costs related to hospitalization, including medical tests, RT-PCR, blood tests, and CT scan reports, are covered under pre-hospitalization expenses.

What is a Post-hospitalization expense?

Post-hospitalization means all expenses or charges incurred by an individual policyholder once he/she is discharged from the hospital. Your doctor may prescribe some more tests to evaluate your progress or recovery. Depending upon the insurer, the number of days covered under the post-hospitalization policy varies. Most insurance companies compensate for the charges incurred by an individual policyholder for 60 days from the discharge date. Expenses related to acupuncture, naturopathy, etc., are not covered post-hospitalization expenses. Some of the expenses that are covered under post-hospitalization are,

• Medicines and drugs
• Laboratory reports
• Therapies related to the condition (e.g., physiotherapy)
• Consultation fees for physicians

Let’s understand what is pre-hospitalization and post-hospitalization expenses in the case of Mrs. Bhagchi.

Mrs. Baghchi (56-years-old) lives in Pune with her family. Mrs. Baghchi was hospitalized for the treatment of typhoid on 3rd July 2021. But she had experienced the symptoms from a week before the hospitalization. In her case, the pre-hospitalization phase should involve events like visiting the doctor, conducting all the tests, taking prescribed medicines, etc. But after one week, the situation got worse. Hence, Mrs. Baghchi was hospitalized for treatment for the next seven days and was discharged on 10th July 2021. After getting discharged from the hospital, she took medications, consulted with doctors, and even performed some tests until recovery. These expenses are known as post-hospitalization expenses.

Some premium insurance products extend this post-hospitalization coverage for up to 90 days. But, in the case of standard Corona Kavach policies, these expenses will be covered for up to 30 days after discharge.

How to claim pre-and post-hospitalization expenses?

Pre-hospitalization expenses

To initiate the pre-hospitalization claim, you need to keep your diagnostic test receipts properly. Always preserve all imperative bills and receipts for a hassle-free pre-hospitalization claim. You can ask your diagnostic centers to email all documents and receipts so they won’t get misplaced easily. You can easily access these documents digitally rather than physically in the time of need.

Post-Hospitalization Claim

Your discharge summary will be an imperative document to claim your post-hospitalization expenses because it contains the details of medications and follow-ups for your ailments. In the case of a reimbursement claim, you first need to pay all the expenses from your pocket, and then, later, your insurance company will reimburse the expenses. Since this will be in addition to your regular hospitalization claim thus, you should file it separately. A post-hospitalization claim pays off all medical expenditures and follow-ups for up to 60 days (in some cases, it may pay up to 90 days). This claim will not be considered a cashless claim, unlike your hospitalization bill. For this, you should submit your documents to initiate a post-hospitalization claim. Most insurance companies offer a window of 7-15 days to policyholders, and within this time, the insured needs to initiate and submit all documents for the claim.

Once your claim gets approved, all your healthcare expenses will be covered up by the insurer company. The costs related to treatment before hospitalization will be considered as the pre-hospitalization expenses. On the other hand, the prices of medicines, medical tests, and physician’s consultation fees after discharge will be compensated for under the post-hospitalization expenses.​

Before initiating a pre-and post-hospitalization claim, all insured policyholders should know the inclusions and exclusions of their health policies to make the claim process hassle-free and avoid the pain of rejection.