Day care treatment

Understand day care treatment meaning, covered procedures, benefits, and claim process under group health insurance.

What is day care treatment?

Day care treatment refers to a medical procedure or surgery that does not require hospitalization for 24 hours due to advancements in medical technology. These treatments are completed within a few hours, allowing patients to return home the same day.

Common day care treatment examples

Here are some of the common day care treatment options covered under health insurance:

• Minor surgeries: Hernia repair, tonsillectomy, sinusitis, or minor orthopedic operations.
  
• Diagnostic tests: Endoscopy, colonoscopy, and other diagnostic procedures requiring short-term hospitalization.
  
• Chemotherapy and dialysis: Regular procedures for chronic conditions like cancer and kidney disease.
  
• Infusion therapies: For various medical conditions that require medication administration via IV, such as iron deficiency or autoimmune disorders.
  

Advantages of day care treatment

• Covers advanced treatments completed in a short duration.
  
• Reduces out-of-pocket medical expenses.
  
• Provides access to modern healthcare (laser, robotic, or laparoscopic procedures).
  
• Protects employees from financial burden due to high OPD or surgery costs.
  
• Suitable for today’s fast-paced medical environment.

Key characteristics of day care treatment

• Coverage applies only if the treatment is done in a registered hospital or day care center.
  
• No need for 24-hour hospitalization.
  
• Listed under the insurer’s approved day care procedure list.
  
• May include pre- and post-hospitalization expenses.
  
• Applicable to both individual and group health insurance policies.

How does day care health insurance work?

Here’s how day care coverage functions under a health insurance plan:

1. Diagnosis & recommendation: The doctor recommends a treatment that doesn’t need 24-hour hospitalization.
   
2. Pre-authorization: The hospital sends a pre-authorization request to the insurer or Third-Party Administrator (TPA).
   
3. Treatment: The patient undergoes the procedure and is discharged the same day.
   
4. Claim settlement:
   
   • Cashless: The insurer directly settles the bill with the hospital.
     
   • Reimbursement: The insured submits bills and reports to claim expenses later.

Day care treatment covered under group health insurance

Group health insurance policies cover several day care procedures that employees or their dependents might need. Some common examples include:

• Cataract and other eye surgeries
  
• Chemotherapy and radiotherapy for cancer
  
• Dialysis for kidney-related issues
  
• Hernia repair, tonsillectomy, and sinusitis surgeries
  
• Endoscopy, colonoscopy, and minor orthopedic operations
  
• Lithotripsy (for kidney stones)
  
• Abscess drainage or wound suturing

Each insurer provides a specific day care treatment list in the policy document.

Process of filing day care claims in group health insurance

For cashless claims

1. Get admitted to a network hospital.
   
2. The hospital sends a pre-authorization form to the insurer or TPA.
   
3. Approval is usually granted within a few hours.
   
4. The treatment is carried out, and the insurer settles the bill directly with the hospital.

For Reimbursement Claims

1. Pay the hospital bills at the time of treatment.
   
2. Collect all relevant documents (bills, medical reports, discharge summary).
   
3. Submit the documents to the insurer or TPA.
   
4. The claim is processed and reimbursed to your account within the specified timeline.