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Understanding the Difference between OPD and Day Care Treatments

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If you are reading this, you are already aware of the importance of having medical insurance.It can protect your finances during medical emergencies, while allowing you to opt for quality healthcare facilities. But the policy can have several terms and conditions that may be confusing. Which is why, you should be well-aware of the inclusions and exclusions. For instance, there’s always some doubt regarding whether the health plan will cover day care treatments and outpatient department (OPD) treatments. Note that these two are different and your policy will have different clauses for both. Read on to know why.

What is OPD Treatment?

Some illnesses or injuries do not require hospitalisation. They can be diagnosed and treated without getting admitted to a hospital, such as dental treatments, fractures, etc. In medical parlance, this is called OPD or Outpatient Department treatment. In OPD, the patient consults the doctor in their clinic or consultation room of any hospital for treatment or diagnosis of any health issues. There’s no need for hospitalisation. Suppose you have a stomach pain and want to consult a doctor just for a check-up.This can be done in OPD.

What is Day care Treatment?

Day care treatments or procedures refer to those treatments, surgeries or medical procedures which require hospitalisation but not for more than 24 hours. Due to advancements in medical science and technology, many medical procedures, which earlier required prolonged hospital stay, can now easily be done within a few hours now. The patient is discharged within 24 hours. Some day care treatments are chemotherapy, radiotherapy, cataract surgeries, dialysis, etc.

OPD Treatment vs Day Care Treatment

Here are the key differences between the two.

• Hospitalization:

The main difference between OPD and Day Care treatment is hospital admission. While day care procedures require a few hours of hospitalisation, OPD does not require any hospitalisation.

• Scope of insurance coverage:

Most health insurance policies cover day care treatments while OPD is usually not covered unless specifically mentioned.

• Sum insured:

In day care treatments, you can claim up to the sum insured while OPD treatment comes with a sub-limit. You cannot claim up to the sum insured.

Claim Settlement

In OPD treatment, you need to make the payment yourself and get it reimbursed after submitting the necessary documents. But in day care procedure, the process of filing claims is similar to regular hospitalisation. You can opt for cashless or reimbursement method based on the hospital. If you select a network hospital for undergoing the treatment, you can avail cashless facility wherein the insurance provider will take care of all the expenses. But you need to inform the insurer in advance before getting hospitalized and provide the necessary documents. In case of reimbursement claim, you need to pay for all the expenses and raise a reimbursement claim. The claim will be settled within a few days.

Conclusion

All in all, amedical insurance policy comes with certain terms and conditions. And knowing the difference between OPD and day care treatments can help you select the right plan so that you can avail quality healthcare facilities without worrying about the expenses.

Disclaimer: The above information is for illustrative purpose only. For more details, please refer to policy wordings and prospectus before concluding the sales.

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