Things to Know About Inpatient and Outpatient Health Care Costs

Posted by mbsplus on April 3rd, 2019

There are significant differences between inpatients and outpatients not only in terms of hospital services but also in patient billing and collections. Understanding which applies to you will help you figure out if your checkup or hospitalization will be covered by your insurance plan or health card, or if you need to pay from your own pocket.

Inpatient

You're classified as an inpatient when you need to stay in a hospital for one day or more for your treatment. It's mainly for doctors to monitor you closely before and during surgery or any other medical procedure and while you are recovering. Even if you're admitted only for a day, you're considered an inpatient as long as your doctor writes an order for you to stay in the hospital for a prolonged period.

The billing and collection for inpatients are usually done when you're about to be discharged from the hospital. Surgeries, treatments, or other services will be done first; then, you pay for it.

In some instances, a doctor's note for your admission is needed for your insurance or health card to cover your whole stay. The fees for the room and equipment you have used and for the professional who has attended to you is part of the coverage. Sometimes, the medicines your doctor has prescribed you are also covered.

For the most part, if you're covered by an insurance plan or a health card, there will be an agreement between your insurance plan or health card provider and the hospital first before you can be accommodated, especially if you have to be admitted.

Outpatient

You're considered an outpatient if you're only visiting the facility for checkups, injections, wound treatments, etc. This means that the medical service doesn't require hospital admission. You may stay overnight in a hospital, but you'll still be an outpatient. One such instance is when your doctor wants you to undergo an x-ray or other examinations, and you have to stay the whole night for those services.

While inpatients are billed after treatment, outpatients need to make the necessary payments first before undergoing treatments or examinations.

Health card and insurance coverage for outpatient services depend on the plan or agreement that you have signed with your health card or medical insurance provider. There are certain treatments and other health services that health cards and insurance plans don't cover.

For a smooth process in patient billing and collections, it's important to understand the differences between inpatients and outpatients. It's always an advantage to know if your next appointment with your doctor or a medical emergency will cost you money or not.