Can You Claim Health Insurance for Hospitalization of Less than 24 Hours?

Health insurance policies are designed to cover a range of medical expenses, including both emergency and planned hospitalizations. Generally, insurance companies require the insured to be admitted to a hospital at least 24 hours to qualify for a medical insurance claim. But what happens if your hospitalization lasts for less than 24 hours? Is it still possible to file a claim? Read on to find out.

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      Is it Possible to Claim Health Insurance for Hospitalization of Less than 24 Hours?

      Yes, it is possible to claim health insurance for hospitalization that lasts less than 24 hours. Traditionally, most health insurance policies required a minimum of 24 hours of hospitalization to approve claims. However, with advancements in medical technology and the introduction of procedures that do not require prolonged stays, insurers have adapted their policies to cover shorter hospital visits under specific conditions.

      The scenario where health insurance claims are accepted for hospital stays of less than 24 hours includes day care treatments. However, you must meet specific terms and conditions, if any, set by your insurer to successfully claim health insurance for hospitalization of less than 24 hours.

      Day Care Treatment in Health Insurance

      Day care treatments in health insurance are medical procedures or surgeries that can be completed in less than 24 hours because of technological development, which would have otherwise required a hospitalization of 24 hours.

      Some common day care treatments included in mediclaim insurance plans are as follows:

      • Cataract surgery
      • Tonsillectomy
      • Chemotherapy and Radiotherapy
      • Haemodialysis
      • Coronary angiography
      • Nasal sinus aspiration
      • Free skin transplantation
      • Arthroscopic knee aspiration

      Almost all health insurance companies in India provide coverage for day care treatments. The only difference is that the list of treatments and surgeries covered varies from insurer to insurer. However, you should note that Outpatient Department (OPD) expenses like doctor consultations, tests and investigations are excluded from the scope of day care treatments, although they might also require hospitalization for less than 24 hours.

      OPD treatments differ from day care treatments in the sense that OPD treatments do not require hospitalization at all. On the other hand, day care treatments require hospitalization, but the duration is less because of medical advancements.

      In case you missed it: OPD Cover in Health Insurance

      Things to Keep in Mind While Raising Claims for Day Care Treatments

      When filing a claim for day care treatments, it is essential to keep the following tips in mind:

      • The treatment must be deemed medically necessary and prescribed by a qualified doctor.
      • The patient should be admitted to a hospital or day care center for the treatment.
      • The procedure should require less than 24 hours due to advancements in medical technology.
      • Ensure the treatment or procedure is listed in your insurer's day care treatments list.
      • Keep all essential documents ready, such as doctor's prescriptions, bills, diagnostic reports, and discharge summaries.
      • Be aware of treatments or procedures that may not be covered under the day care category, such as cosmetic treatments.

      FAQs

      • Q1. Is 24-hour hospitalization mandatory for insurance claims?

        Ans: No, 24-hour hospitalization is not mandatory for all insurance claims. Most insurance policies cover day care treatments that do not require a full day of hospitalization.
      • Q2. What is day care treatment in mediclaim?

        Ans: Day care treatment refers to medical surgeries or procedures that require less than 24 hours of hospitalization due to developments in medical technology. These treatments can be done in a few hours, and the patient can go home the same day. Examples of day care treatment include cataract surgery, chemotherapy, etc.
      • Q3. Is day care treatment and OPD the same?

        Ans: No, day care treatment and OPD are different. Day care treatments involve medical procedures where the patient stays in a hospital for a short period, less than 24 hours, while OPD refers to consultations or treatments where the patient does not need to stay in the hospital at all. OPD services include doctor visits, routine health check-ups, etc.
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      Disclaimer: The list mentioned is according to the alphabetical order of the insurance companies. Policybazaar does not endorse, rate or recommend any particular insurer or insurance product offered by any insurer. For complete list of insurers in India refer to the Insurance Regulatory and Development Authority of India website www.irdai.gov.in

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