Are your expenses outside the hospital covered by your insurance company?


Aug 19 2022


If you are admitted to the hospital, there is a good chance that your insurance will cover all or part of the cost. However, there are some pre-hospitalization expenses and post-hospitalization expenses that your insurance may not cover.  Understanding what your health insurance plan covers and what expenses are not covered is an essential part of planning for your hospital stay. Most hospital expenses are either part of your deductible or not covered by your insurance. There are some expenses that your insurance plan should cover. Let’s look at what  ManipalCigna ProHealth Prime Insurance Packages covers outside of your hospital stay.


What Pre-Hospitalization Expenses Does My Insurance Plan Cover Outside a Hospital Stay?

ManipalCigna ProHealth Prime Insurance packages cover the pre-hospitalisation expenses. The expenses that are covered include – OPD consultation, pharmacy expenses, wellness offerings along with diagnostics such as blood tests, urine tests, and X-ray tests, among others that are recommended by doctors and physicians to accurately diagnose a medical condition. In addition to the above mentioned covers, they also provide Road Ambulance and Air Ambulance across their packages.

In most cases, all expenses incurred by the policyholder 30 days before hospitalization come under the ambit of pre-hospitalization costs which includes outpatient expenses in the case of ProHealth Prime Advantage package and Convalescence Benefit in the case of ProHealth Prime Active Package.

What Post-Hospitalization Expenses Does My Insurance Plan Cover Outside a Hospital Stay?

An insurance plan is not designed to cover all of the medical expenses. The insurance company agrees to cover you in an emergency, as per the contract between you and the company. The contract also says that you are responsible for bearing most of the medical expenses if they are outside of an emergency or the hospital. This agreement requires you to know the composition of all the covers it provides and covers it does not. While related therapeutic services like acupuncture and naturopathy are not covered as charges by insurance plans, post-hospitalization costs like diagnostic tests indicated by the consulting physician to monitor the progress of a patient's recovery, consulting fees, and medical costs are.


Policyholders can submit proof of receipts, along with a doctor's certificate and discharge summary, to claim both pre- and post-hospital expenses. To get the greatest benefits, they should be fully aware of all inclusions and exclusions in their health coverage.



What about Non-Medical Expenses?

The majority of the time, the insurance companies' policies determine if an incurred medical bill is required or not. Syringes, hand gloves, and registration fees, among other non-medical expenses that don't come under the categories of drugs, consulting, or diagnostics, are all covered under ManipalCigna ProHealth Prime Insurance Packages. We are aware that these expenses greatly contribute to hospitalization fees and mount up quickly. Having said that, there is a list of non-medical costs that the policy does not cover. These exclusions are detailed in the policy paper, which you can view. Administrative expenses, surcharge fees, attendant's meals or other costs associated with investigations unrelated to the patient's illness, eligibility for room rental, and consumables like wearables that are not covered by the policy outside of the hospital are a few of them.

How to Calculate How Much My Insurance Will Pay For

There is a simple procedure you can use if you're unsure of how much your health insurance company will cover aside from your hospital stay. The reimbursement rate from your insurance provider must be known first. Your insurance company will pay this sum for each service done. Then, you must understand what is protected by your insurance policy. You can find this on the website of your insurance provider or by getting in touch with customer care. Once you are aware of the coverage provided by your insurer, you can easily reduce the reimbursement percentage from the overall cost. This will provide you with a rough estimate of what your insurance will cover.


It is vital to comprehend what a protection plan covers and what it doesn't, prior to purchasing an arrangement. Ensure you comprehend the agreements of your arrangement before you go to the emergency clinic. This will assist you with keeping away from any confusions or monetary difficulties later on. Be that as it may, assuming that you have any worries about what your protection plan does or doesn't cover, you ought to contact your insurance agency as quickly as time permits. The motivation to purchase health care coverage is to keep away from a clinical emergency in money and subsidizing. Yet, do comprehend that a few costs must be borne by the policyholder even in spite of conveying a credit only wellbeing card of a complete wellbeing plan or utilizing a TPA or an organization medical clinic.