The Difference Between Inpatient and Outpatient Procedures - United Benefits

The Difference Between Inpatient and Outpatient Procedures

It’s essential to understand the difference between inpatient and outpatient care, especially when it comes to knowing how your insurance covers claims and what you’ll have to pay out of pocket. Insurance plans can cover inpatient and outpatient services in different ways, and if you don’t know the difference or how your hospital coded your services, you could end up with an unpleasant surprise on your bill. In addition, if you have a hospital indemnity policy, your reimbursement from the policy will differ based on whether or not you were an inpatient or outpatient at the hospital.

What Does Inpatient Mean?

If you’re an inpatient, it means you’ll have to stay overnight in the hospital. Being classified as an inpatient means you’ve been admitted to the hospital. This could be due to a surgical procedure, your doctor’s recommendation, a chronic illness that needs special hospital treatment, or after a trip to the ER. The number of days a patient is classified as an inpatient is based on the number of midnights they spend in the hospital. Inpatient charges include your room and board; however, depending on the policies and practices of the hospital and doctors, there may be additional charges such as facility fees and separate doctor or hospitalist fees. The average overnight hospital stay for an inpatient is $11,000, which means you are likely to meet the out-of-pocket max in your health insurance plan.

What Does Outpatient Mean?

Outpatient hospital services include labs, x-ray, radiology services, outpatient surgery, and wound care. In addition to those, you may find yourself in an observation stay. This means you stay in the hospital overnight so the doctor can observe your progress. This could be after a surgical procedure or emergency room visit. The doctor needs to make sure everything is going smoothly. There are no set rules on how long a person can be classified as an observation patient. However, Medicare allows no more than 48 hours under observation before a patient must be moved to inpatient status. Outpatient costs will vary on the procedures and if your plan has copays or coinsurance for the specific services you had.

Worried About Hospital Expenses?

If you’re worried about the cost of hospital services, getting a hospital indemnity plan can help. This type of plan will give you a set amount of money for each time you get hospital services – inpatient or outpatient. It’s a great way to make sure you’re covered if you ever need to go to the hospital. Contact us to learn more about how you can benefit from a hospital indemnity plan. A United Benefits Specialist can help you explore your options.

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