Difference between OPD and IPD Treatment

OPD (Out-patient Department) and IPD (In-patient Department) have different meanings and scopes of coverage. In this article, we explore both OPD and IPD treatments and the claim processes.

What is OPD (Outpatient Department) ?

OPD (Outpatient Department) refers to all the healthcare services you can avail of without getting admitted to a hospital. Diagnostics, doctor’s consultations, and follow-up appointments fall under OPD care. You must remember that OPD care is not limited to hospitals, but can be availed in clinics, diagnostic centres, and virtually.

What is IPD (Inpatient Department) ?

The Inpatient Department, or IPD, refers to the comprehensive medical services provided to an individual admitted to the hospital for more than 24 hours.

Key Differences Between OPD and IPD

Do I Need An Appointment For OPD Care?

No, OPD care is flexible and can be availed for unexpected health concerns without an appointment. Your health insurance policy covers you for doctor’s consultations, diagnostics, and other OPD facilities. You can access medical care without prior appointments, helping you cater to medical emergencies.

However, there are certain key points you must keep in mind:

1. Wait Time

   When seeking OPD treatments, you must be prepared for potential wait time, as patients with prior appointments will be prioritized.

2. Accessible Walk-ins

   OPD treatments and services are accessible as walk-ins for urgent needs. 

3. Access OPD Care Online

   Post-COVID, OPD care was revolutionized, with blood test samples collected from home, doctor online consultations, and more making OPD efficient. However, check whether your health plan covers the same. 

4. Emergency Hospitalization

   Visit emergency care for health emergencies instead of OPD care.

What Does OPD Care Cover?

Some common coverage terms and conditions under OPD care are:

• Doctor’s consultation fee
• Diagnostic tests like blood samples, X-rays, ultrasounds, etc.
• Pharmacy bill for prescription medicines
• Dental care and eye check-ups
• Medical procedures like wound dressings, etc.

traordinary Facts

Recently, the National Health Authority achieved 4 Crore OPD registrations through ABHA-based scan and share service. Most of these registrations came from Uttar Pradesh, Andhra Pradesh, Karnataka, and Jammu & Kashmir.

What Does IPD Cover?

Some common coverage terms and conditions under IPD are:

• Hospitalization cover
• Room rent
• ICU cover
• Medical treatments and procedures
• Pre and post-hospitalization, etc.

How To Claim For OPD and IPD Medical Care?

Specific steps are involved in the claim process of OPD and IPD medical care.

OPD Claims

Step 1 - You need to pay upfront at the time of availing OPD care like diagnostic tests, doctor consultations, etc.

Step 2 - Collect all your bills, reports, and other relevant documents related to your OPD care.

Step 3 - Submit your claim form along with collected documents to your insurer for OPD claim reimbursement.

Step 4 - Once your insurer verifies your documents, your claim amount is reimbursed based on your health policy terms and conditions.

IPD Claims

IPD claims can be processed as cashless and reimbursement claims, let us look at each one separately.

OPD Vs. IPD: Opting for The Right Treatment

If you are wondering when to select OPD or IPD treatments, here is your answer:

Go for OPD treatments if,

• You want a routine check-up
• Minor procedures (daycare) that do not require hospitalization, for example dialysis
• Diagnostic tests
• Pharmacy requirements
• Preventive health care services such as annual health check-ups

Go for IPD treatments if,

• You require hospitalization for 24 hours or more
• Emergency cases like accidents, heart attacks, etc.
• Maternity, and newborn care
• ICU care
• Critical illness surgeries, or operations

OPD and IPD: Two Pillars of Health Insurance

Both OPD and IPD play important roles in securing your health. They are both important pillars of the healthcare system in India serving different purposes.

While OPD caters to minor healthcare needs like daily check-ups, diagnostic tests, and others. IPD caters to the serious health conditions requiring hospitalization for more than 24 hours. Understanding the difference between both is crucial before purchasing a health insurance plan in India.

If you are seeking expert guidance regarding the best OPD and IPD health plans in India, schedule a personalized call with our insurance experts today!

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