Opd Outpatient - Ipd Inpatient Heath Insurance Question

[yannic]

a question about the mentioned Outpatient OPD and Inpatient IPD. Some insurances offer either IPD, or IPD and OPD.

If someone has a local health insurance with only IPD coverage, meaning hospitals and accidents are insured.

What happens if you have an illness but don't know for sure, you go to the hospital, doctor checks you up and finds something wrong, orders more checks, like blood check, ultrasound, CT Scan. Then it is found out that there is a serious illness like a tumor or something like that which requires an operation.

So finally all pre-check ups have been done and you are finally hospitalized. Will all those prior check-ups until you are hospitalized be paid from the IPD insurance or will those be treated as OPD visits and are on your own charge?

Thanks for any insight.

[stevenl]

Yes, that will be covered. Now if the scan's etc. show there is no serious illness and hospitalization is not required it will not be covered.

[yannic]

thanks a lot for your answer, that sounds logic.

[kamalabob2]

I would agree with Stevenl on how it really works with a good company such as BUPA Thailand or Thai Health Insurance. In most in patient policies the FOLLOW UP out patient procedure to your in patient procedure will be covered, but you pay the hospital for that follow up procedure and then submit proper paperwork for a prompt full repayment by BUPA or Thai Health Insurance. BUPA did a direct deposit to my Thai bank account for follow up hospital short visit in a very prompt manner.

[madgolfer]

I have health insurance with a UK based company....I have coverage for Inpatient Services only....I have a $2000 co pay (excess)

Hurt my shoulder...went to the Hospital (Pattaya Bangkok) got a quaterzone injection and they said see what happens if OK no problem...was Ok for a few months then pain came back....went back and they said we think you need an MRI to check for damage but try another injection and if no good we need to investigate further.

No good a month latter so I advise my Insurance company of whats happening looks like there could be a problem...they send me the paperwork to make a claim....I go have an MRI...shoulder is in need of surgery...tendons off the bone etc....hospital gets pre approval for surgery and a week later I have the operation 2 nights in hospital. Insurance company paid for everything only from the time i was admitted til I was discharged.

I need to get the wound dressed when I get out for a few weeks and I need to get the stitches out.

I make a claim for..2 visits regarding the shoulder that I got injections.....a visit to the surgeon who organises an MRI....I have the MRI....I go back see see the surgeon another visit for results...also make claim for dressing of wouds and also to have the stiches removed.

ALL CLAIMS REJECTED AS CLASSED AS OUT PATIENT SERVICES...

The Hospital and Doctors did a great job and shoulder is getting better now...

I had a second look at my policy.....and yes they were right all outpayient services....silly me thought that being directly part of something that was approved as an inpatient service would encompass those as well.....wrong....beware.....

[stevenl]

Local health insurance, as enquired about by the OP, will cover diagnosis that leads to hospitalization.

It sounds to me like your first 2 injections were not part of diagnosis but were treatment, MRI IMO should be covered (and will be covered by my Bupa), but don't know your policy conditions.

[Youpi88]

Plain and simple: when you have a plan that covers only in-patient, there is usually a line that says something like "Out-patient is covered within 15 days from the hospitalization".

So anything that happened 2 weeks or more prior to the surgery will not be covered, no matter if related to the surgery or not.

The insurance company might decide to cover some earlier diagnosis as a commercial gesture, but it's up to them, and it is very unlikely.