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Know Your Insurance: Inpatient and Outpatient Care

Understand your health insurance plan by learning the differences between inpatient and outpatient care, including coverage, costs, and when each applies.

A female patient consulting with a doctor using a tablet in a hospital setting to discuss insurance coverage options and medical care details.
A female patient consulting with a doctor using a tablet in a hospital setting to discuss insurance coverage options and medical care details.

What You Need To Know

The trip of a lifetime is looming on the horizon, or perhaps a long-term relocation is imminent. Healthcare is at the forefront of your mind. You want to ensure you receive the best possible care when you need it. And you want to protect yourself in the case of an emergency. Therefore, you pore over information about the pros and cons of different policies.

Finally, you settle on the right course of action. You feel confident that you’ve compared health insurance plans. When phrases like “inpatient care” and “outpatient care” pop up, you’re not overly stressed. You’re signed up for excellent care, after all. What difference can it make? Turns out, it’s a lot!

Inpatient and outpatient care are terms that refer to the types of healthcare services provided. The kind of care you get will depend on the type of treatments you need, your long-term prognosis, and, in some cases, your insurance policy. These are words you’ll want to know!

Understanding Inpatient Care

Inpatient care refers to any care that necessitates admission to a hospital. To clarify, it relates to the formal admission process.

If you need to visit the emergency room and the staff asks you to stay a bit longer for some follow-up observation, you haven’t been admitted as an inpatient. You’re just being watched until you’re sent home!

In many cases, inpatient care can be a welcome relief. It isn’t used for everyday minor or moderate maladies. You are unwell to the extent that your medical team wants you in a safe and secure environment.

You will be treated, cared for, observed, and possibly prepared for surgery or other serious treatment. Caring professionals surround you. While you might not be feeling great, there is comfort in knowing that you’re getting the medical care you need.

Cost of Inpatient Care

Inpatient care is expensive – sometimes devastatingly so. Ensure your insurance policy has generous coverage for inpatient care.

It isn’t easy to imagine just how quickly costs can add up. You’re responsible for the costs of both your treatment and being housed, observed, and cared for by the hospital staff.

You will also want inpatient coverage that includes care in private hospitals. In many countries, individuals receiving inpatient care are required to make their own arrangements for food and personal hygiene care.

This is a real challenge if you have no family nearby and you don’t speak the language. Private facilities that cater to all your needs and concerns can make all the difference.

Understanding Outpatient Care

Outpatient care refers to any care or treatment program that occurs without a formal inpatient admission. It can also be the care you receive after completing an inpatient admission.

Examples of outpatient care include day surgeries, many mental health programs, medical situations that require follow-up care, and consultations with specialists.

In general, outpatient care is less expensive because you are only paying for your care and not for the cost of staying at the hospital. However, just as inpatient care can come with some unexpected expenses, outpatient care can also incur some unexpected costs.

The cost of arranging comfortable transportation and parking can soon add up with follow-up visits. Seemingly simple day surgery procedures might require personal nursing care.

While it may come as a relief that you don’t require hospitalization, your everyday life and employment may be put on hold as you recover at home.

Thankfully, some insurance plans include follow-up care that’s required post-treatment. Nursing care, personal support worker care, and in some cases even the cost of having a family member come to be by your side can be supported with the right insurance policy.

Communicate With Your Healthcare Team

While it is often obvious why some medical situations require inpatient care while others require outpatient care, some cases are more subjective.

The availability of hospital beds, a patient’s past health history, and the doctor’s underlying intuition can all factor into the decision of whether one patient will be formally admitted. In contrast, another patient in similar circumstances is sent home.

If you believe there are underlying circumstances that may influence your prognosis, be vocal about them. Let the doctor know that you have limited resources as an expat, with no family to stay by your side at home as de facto nurses.

Or if the hospital environment makes you anxious and you have the support you need to recover at home, please let your team know. While the doctor’s verdict is paramount, your preferences will be taken into consideration where possible.

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Andrew Blomberg| Vice President of Global Benefits

Andrew Blomberg is the Vice President of Global Benefits at ICI, leading innovative insurance strategies for organizations worldwide. An MBA-educated, multi-licensed expert, he specializes in optimizing global benefits programs and guiding clients through complex challenges.

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