Health Insurance Articles
What Outpatient Status Means For Your Health Insurance And The Medical Tests It Will Cover
2010-05-19
Inpatient and outpatient status are important terms to know and understand, as they greatly affect your health coverage. These statuses refer to whether or not a patient is required by a doctor to stay in a hospital during treatment. As you might assume, an inpatient is typically a patient that must stay in a hospital overnight, and an outpatient is typically a patient who is released from the hospital to his or her home. However, the designation is not always this clear cut. Insurers have different methods of calculation when it comes to outpatient and inpatient status, and statuses affect policies in different ways. Taking some time to understand the key differences is crucial in order to better understand and shape your health insurance (especially if you've been comparing several policies or looking for a new health care insurance policy).
In some cases, an outpatient may still stay in a hospital overnight. This can seem confusing, but the legal requirements for outpatient and inpatient status don't specify a hospital stay. Instead, the type of testing authorized by a doctor and the nature of the disease may affect your status as a patient. If you've been classified as an outpatient, you could potentially receive less help on bills from your health insurer. Your co-pay will usually be higher. The health insurance company may cover less testing and less of the total cost of medications, although the specific tests covered by your policy will vary from insurer to insurer. In order to find out, it's important to read your policy. Look for any language in the exclusions that mentions outpatient or inpatient status. If you don't fully understand the policy, be sure to talk to your insurance agent--they can easily explain what will and won't be covered. They can also shed some more light on how outpatient and inpatient status are decided, which can be extremely helpful. If you've recently been in a hospital, they can also let you know very quickly what to expect, and whether or not you'll be granted inpatient or outpatient status (other patient status types may even be available).
Knowing your healthcare company's policy will help you to determine your status and rights as a patient. You should also review state law regarding required coverage, co-pays, testing, and the like, as certain laws may legally compel your insurance company to provide certain statuses, tests, etc. Your doctor may also be a helpful source of information, particularly if you've been diagnosed with a disease or condition that will require significant testing and treatment. Do a little bit of research and find out all you can about an outpatient status.
