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How Daycare Treatment is different from OPD Treatment?

In this tech-driven world where health insurance plans are readily available at the click of a mouse, resorting to the old-fashioned ‘through-the-agent’ means is so passe. What the latter entails is a series of misinformation on the agent’s part while the policy holder puts in little to no effort in learning the basics of a policy they are buying.

If you have made the shift from using an agent and are personally looking through insurance offers by yourself, then kudos to you. But, the insurance industry, like any other, is filled with clever play of words that a beginner would find hard to understand.

In this page, we will outline the basic differences between day care treatment and outpatient department (OPD) treatment. Although, the difference between the two may not seem like much, there are plenty you need to be informed about when shopping for health insurance policies.

Daycare Treatment:

It is a very well known fact among seasoned policy buyers that an individual must be hospitalised for at least 24 hours to be able to make a health insurance claim. But, as technology has grown exponentially over the last two decades, not all key procedures require day-long hospital visit.

Let’s take the example of an individual undergoing a corrective eye surgery. Up until a few years ago, they would have had to admit themselves to a hospital for at least a few days. However, procedures like LASIK and ICL (Implantable Contact Lens) among others, have cut short a few days long procedure into one that can be carried out in less than an hour.

Some of the most common procedures that are likely to be listed in day care treatment-specific insurance policy include eye surgery, dental surgery, chemotherapy, haemodialysis among others. One point worth noting here is that day care treatments covered in insurance plans differ from policy to policy.

Outpatient Department (OPD) Treatment:

OPD is a treatment wherein certain treatment or diagnosis of a certain type of illness upon the advice of a medical practitioner. This involves the patient visiting the clinic or any of the doctors’ consultation rooms.

While OPD still feels similar to daycare, the actual difference can be explained with the level of hospitalisation involved in either of these cases. For instance, in a day care treatment, a patient needs to be admitted to the hospital for however short a duration to trigger an insurance claim. On the other hand, an OPD is getting a procedure done without needing to be admitted. A perfect example for OPD would be root canal, which could be taken care of with a routine visit to a dentist’s office rather than getting admitted.

How are Settlements Made for OPD and Day Care Treatments?

Making settlements for day care treatments is quite similar to what it is with regular hospitalisation. To make a claim, you would need to submit all the relevant documents regarding the treatment you have availed within the timeline specified in the fine print. There’s also an advantage for you in case of day care treatments as they are usually planned well. For instance, when you getting any of the day care related procedures, you can step into one of the many network hospitals affiliated to your insurance provider. This will enable you to take the cashless route as your insurance company will handle all the payments in your stead. To make this happen, you should inform your insurance provider a few days in advance and also provide all the necessary documentation for the treatment you have availed.

Getting an OPD treatment claim is slightly different from daycare ones as it works like indemnity-based plans. Here, you will need to pay for your treatments yourself and later opt for a reimbursement by presenting all the paperwork. An aspect worth noting here is that OPD treatments usually come with a sublimit and the cost of any breach in limit will have to be borne by you.

To sum it up, health insurance jargons aren’t as hard to comprehend as they are made to be. All that is expected of a prospective policy buyer would be to do their due diligence and read through the terms and conditions of the insurance they are buying.

GST rate of 18% applicable for all financial services effective July 1, 2017.

Disclaimer: Premiums may vary depending upon factors like age, location and prevailing taxes/GST.

Daycare Vs OPD treatment Reviews

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  • Religare Health Insurance
    "Claim Rejected "
    0.5 0.5/5 "Unacceptable"
    My name is thamim razith , I have religare health Insurance with Insurance policy(#10156318), Patient Name : THAMIM RAZITH ,Policy holder name : THAMIM RAZITH - Claim no: 90343460 00,I was hospitalized into Apollo Specialty Hospital ,Madurai due to Dengue fever on 3rd May 2017 at 4 PM noon. I made a post claim for reimbursement of money: 16988 Rupees, I have submitted all medical records , they told that "ADMISSION NOT JUSTIFIED, COULD HAVE BEEN TREATED IN OPD". They are saying that I could have been treated in OPD and admission was not required, then I was able to get medical certificate from Doctors letter(medical certificate) on letter head in which it was mention that admission was necessary and also mentioned about why patient is not treated in OPD treatment process based on WHO guidelines. This medical certificate is also submitted to I have contacted all the concerned person and Grievance Redressal Officer still the case is not resolved.
    Was this review helpful? 0
    , chennai
    Reviewed on Aug 02, 2017
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