Reality About Day Care in Health Insurance

Advanced technology has led to efficient procedures and all the research and advancement has quicker test results. Procedures like angioplasty, removal of gall bladder, cataract etc: take less than 24 hours. Time taken for treatment and medical procedures take less time and the cost is definitely not getting less.There are some treatments and procedures covered by health Insurance which with today’s technology take less than 24 hours – for example angioplasty, cataract etc. Some minor treatments which require hospitalization, due to general anesthesia being administered - for removal of tumors etc. though the patient can be released on the same day.

While time taken for treatment and medical procedures is taking lesser time, it is still not cheaper. Doctors charge you a fairly high amount for procedures like cataract, appendicitis, angioplasty etc which now take far lesser time. Health Insurance generally covers hospital bills that involve at least 24 hours of hospitalization. So what happens to coverage of such procedures that now take less than 24 hours, but cost a lot still? Here’s where the concept of covering day care treatment come into play.

There is a lot of confusion on this concept. Over enthusiastic sales/marketing people from Insurance Companies/Brokers have always pushed customers to buy their products by stating how their plan had a longer list of day care procedures compared to others and had better coverage of day care procedures.

Day Care cannot and should not be evaluated by the number of procedures covered.  An Insurance company could have a list of only 20 treatments, but they could be listed very broadly. For instance, Government Insurers list very broad treatments like "Surgery of the eye", whereas a private sector insurer may list this one category, into 17 detailed treatments under eye surgeries like "removal of foreign body from lens", "removal of foreign body from eyeball", "Cataract", etc.

Broad categorizations with a smaller list can actually be more of an advantage, as they will be more inclusive. An insurance company which lists specific detailed list may not cover a new treatment, as medical science advances rapidly and hence may not pay you in the future for new treatments covered under day care.

Unless you are medical professional, it would be difficult to understand the day care procedures listed in the policy document. Hence when comparing 2 plans with similar benefits and features, always opt for the one that has broader categorization or better still, all inclusive day care procedure.

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Policies that cover "all day care" procedures: Apollo Munich Optima Restore, Max Bupa Heartbeat are some of the policies that don't have a specific list, and specifically mention that all day care procedures are covered.

Policies that cover categories:  All Government Insurers have categories of day care procedures listed. These are also good options to go with. The advantage here is that in case a category of day care procedure is not covered specifically at the time of buying the policy, you can request for inclusion of your specific unlisted procedure to the third party administrators before hospitalization.

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Source: Mahavir Chopra


Source-Medindia