- The difference
- How to buy coverage?
- How to claim?
OPD vs IPD Care in Health Insurance
When it comes to managing your and your family’s health, making the right choices is essential. You might get many conditions in your lifetime, where you need to make such tough decisions in your lifetime. One significant decision you may encounter is whether to opt for Outpatient Department (OPD) or Inpatient Department (IPD) care for your medical needs.
Both options have their own merits, consideration, and understanding. Understanding the difference can help you to navigate decision-making more effectively. This article will give you an idea about OPD vs. IPD, and their features in Health insurance.
What is IPD and OPD?
OPD stands for Outpatient Department and typically means when the care involves receiving medical attention without being admitted to the hospital. It includes consultations, diagnostic tests, minor procedures, and follow-up appointments.
Meanwhile, IPD care means Inpatient Department which entails hospitalization for more than 24 hours for better treatments, surgeries, or medical conditions that require continuous monitoring and proper care.
Difference between OPD and IPD at a Glance
| Basis | OPD | IPD |
| Definition | The department of the healthcare facility where patients receive care without being admitted to the hospital. | The department of medical facilities where patients are admitted for intensive medical care and treatment. |
| Covers | Routine consultation, diagnostic tests, minor treatments, and follow-ups. | A situation requiring continuous monitoring, surgeries, and complex interventions. |
| Nature of Care | Suitable for non-emergency situations, preventive check-ups, and minor illnesses or injuries. Patients visit the healthcare facility. receive the treatment and return home on the same day. | Best care settlement for serious medical conditions, surgeries, and cases where there is a requirement for ongoing observation and treatment. Patients stay in the hospital for a specific duration. |
| Treatment Intensity | Involves less intensive treatment, mainly focused on diagnosis, advice, and prescription of medications. | Offers a higher level of medical intervention, specialized treatment, and post-operative care. |
| Duration of Stay | Patients need to spend a relatively shorter time and leave after receiving care. | Patients have to stay in the hospital for the duration of their treatment, which can range from a few days to weeks. |
| Types of services | consultation with a doctor, diagnostic tests, vaccinations, wound treatment, and routine check-ups. | Major surgeries, organ transplants, complex medical conditions, and recovery after surgeries. |
Why you Must Buy Health Insurance for Yourself?
In this unpredictable world, health insurance serves as a protective shield and offers you peace of mind. Whether you are in the prime of your health or navigating various stages of life, buying the best health insurance plan that covers all the major benefits along with OPD and IPD coverage is the proactive step toward ensuring your well-being.
Check out the considered reasons for health insurance.
- Financial securities in Medical Emergencies Any issue related to health can strike unexpectedly, leading to a heavy amount of medical expenses. Buying health insurance from some of the best health insurance company can safeguard you and provide a financial safety net.
- Accessibility to quality healthcare Health insurance allows you to afford to access a network of healthcare providers.
- Preventive Care Health insurance encourages regular health check-ups and preventive care. early detection can prevent you from escalating minor health concerns into major illnesses.
- Chronic Condition Management Health insurance can cover the cost of all the ongoing treatment and medications.
- Hospitalization and surgery In case of any hospitalization and surgical procedures in the future, health insurance covers all the expenses.
- Retirement Planning Health insurance is the essential component for retirement planning, as your all medical expenses have been covered for the future.
- Tax Benefits Health insurance plans come with tax benefits. However, health insurance premiums are tax-deductible and reduce your overall tax liability.
How to buy Health Insurance with OPD and IPD coverage?
There are a few steps to make sure while selecting a plan that meets your needs along with both OPD and IPD. So stay tuned with us and keep reading the key pointers below for further details:
- Check your healthcare needs Determine the type of medical services that you require and how often you need them.
- Talk to the expert You can easily find a reputable expert online or your best medical insurance advice.
- Understand the Plan options Clear your concern with experts regarding different health insurance plans and understand the details of their OPD vs. IPD coverage. Review the coverage limit, benefits, deductibles, co-payment, and exclusions of all the services.
- Compare the plans Compare the features and benefits of various plans and choose the one that suits your needs and budget. Consider the facts such as premium costs, and extent of coverage for OPD and IPD services.
- Consider Additional Benefits Check if the plan is offering any additional benefits, such as coverage for prescription medications, dental care, or vision care.
- Enroll and make payment Once you have chosen your perfect plan, complete the enrollment process as per the insurance provider’s guidelines. Make the payment to activate your health insurance coverage.
- Keep the documents Keep the policy documents, terms, and details with you for future reference.
Claim Resolution Procedure of OPD vs IPD
The claim resolution procedure for both OPD and IPD healthcare services involves a series of steps to ensure that you will get the reimbursement of coverage for medical expenses. Here are the procedures that you can follow for the claim resolution procedure
| STEPS | Claim Resolution for OPD | Claim Resolution for IPD |
| Step 1 | Receive the service: Undergo the necessary outpatient treatment, consultation, diagnostic tests, or any of the procedures as prescribed by the doctor. | Receive the service: Undergo the necessary inpatient medical treatment, surgery, hospitalization, or other procedures as prescribed by the doctor. |
| Step 2 | Keep Records: Keep detailed records of all the medical services received, including bills, invoices, prescriptions, and receipts. | Notify your Insurance Provider: Inform your insurance company about your hospitalization as soon as possible. |
| Step 3 | Submit Claim Form: Download or collect the claim form from your insurance provider and fill it out accurately. | Complete pre-authorization process: Insurance companies require pre-authorization for some IPD treatments. Follow the process to get pre-authorization done. |
| Step 4 | Attach all the supporting documents: You need to attach all the supporting document which includes, bills, invoices, prescriptions, diagnostic reports, and any other relevant documents. | Treatment Procedures: Receive medical care during your hospital treatment. |
| Step 5 | Submit Claim: Submit the completed claim form and the documents to the health insurance company. | Gather the document: Collect the relevant documents, including hospital bills, discharge summaries, medical reports, etc. |
| Step 6 | Claim Review: Your claim form and documents will be reviewed by the insurance provider to verify the information provided and to make sure whether the services are covered under your policy. | Submit Claim form and documentation: Fill out the claim form and attach all the required supporting documents. |
| Step 7 | Claim Processing: When the claim is reviewed and approved, your claim will be processed and the insurance company will calculate the eligible reimbursement amount based on your policy coverage and terms. | Claim Review and Processing: Your claim form, documents, and other necessary documents will undergo the review process. |
| Step 8 | Reimbursement: As per your insurance policy, you will receive the reimbursement or the payment will be provided directly to the healthcare provider. | Claim Settlement: After the approval of the claim, the insurance company will reimburse your amount against the medical expenses or might directly pay the hospital. |
Bottom Line
When it comes to making informed choices about medical care, it is necessary to understand everything related to the care including OPD vs. IPD care. Health insurance is your safety net, which covers you with healthcare, preventive services, chronic conditions, and much more. To choose the right plan with both OPD and IPD coverage, you need to be well aware of your health needs and family history. If any doubt regarding the policy and comparison, ask an expert.
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Written By: Simran Saxena
An explorer and a curious person, Simran has worked in the field of insurance for more than 3 years. Travelling and writing are her only passion and hobby. Her main agenda is to transform insurance information into a piece that is easy to understand and seamlessly solves the reader’s query.
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