OPD vs IPD – OPD Full Form and IPD Full Form in Medical, their Coverage and Benefits

Updated on Jan 30, 2024

Understanding how OPD and IPD are two different terms in medical science, their coverage in health insurance plans and the key benefits provided by insurance for both.

What are the OPD Full Form and IPD Full Form in Medical Terms?

What is OPD full form in Hospital or in Medical Terms?

OPD full form in the medical domain is Out-Patient Department.

What is IPD full form in Hospital or in Medical Terms?

IPD full form in the medical domain is In-Patient Department.

OPD vs IPD – What is the Difference Between Out-Patient Department (OPD) and In-Patient Department (IPD) Treatment?

The pandemic at present has provided people with a wake-up call that has been as good as any as they may have ever received in their lives. Therefore you are seeing people accord a greater degree of seriousness to healthcare. For example, they now know that the IPD full form is in-patient department and OPD full form in the medical domain is out-patient department. There is a significant amount of debate regarding the existence of proper healthcare infrastructure. However, if you have the right coverage, it could play a major role in making sure that you get proper treatment when you need it. This is why it has become so important now to choose the best health insurance policy for yourself as well as the ones dependent on you.

Also Read: Pradhan Mantri Suraksha Bima Yojana (PMSBY) Scheme

Reasons Why You Must Think of Buying a Health Policy for Yourself?

Before you get to know more about Out-Patient Department and In-Patient Department you must know the reasons why it has become so important these days to get the right health insurance plan for yourself. The first such reason is that our lives have become rather sedentary nowadays. This applies to so many of us. This is the reason why younger people are now suffering from diseases that were earlier the sole preserve of the elderly.

The most prominent examples of the same are diabetes, respiratory problems, and obesity, to name a few. Such knowledge is just as important as knowing IPD and OPD full form. We must also take into account the matter of inflation. The term inflation means the rate at which the prices increase for various things over a certain amount of time. As unfortunate as it sounds, medical inflation has been one of the highest in this regard in recent times. It is hovering in the region of 18 to 20%.

Also Read: Difference Between Day Care Treatment And OPD Treatment

What is In Patient Department (IPD) – An Overview?

After the evaluation by the medical specialists’ patients are shifted to the IPD for further treatment. IPD meaning, the in-patient department which might be a room, intensive care, or a surgical unit based on the level of intensity of treatment required.

The cost of treatment in the In-Patient Department has increased exponentially hence the best way to prepare oneself for such a financial need a health insurance plan is much required. And investing in a good health insurance plan early on in life is considered wise. That way, you would be able to save money on premiums apart from besting the inflation rate in the future.

These policies also offer your family great protection. Rather than having to buy separate medical coverage for each member of your family you can easily buy a family floater plan and cover them all under the same policy. These family floater plans normally cover people who are economically dependent on you such as your parents, children, and spouse. Thus, it is a great way to make sure that you are protecting your loved ones. Having these policies also helps you keep your savings secure. As you would know already, healthcare is one of the easiest ways in which your savings can be depleted.

Also Read: Health Insurance Plans with OPD Expenses Coverage

A Few Things to Know About the Coverage You Get from Health Insurance Plans

Do you know what IPD vs. OPD is? If you do, it is good. It is also important in this case to know the various benefits and features that you can get from these policies. The first such feature is the coverage that you get for your hospitalization expenses. These health plans cover all the money that you spend when you get admitted to a hospital as a patient for over 24 hours. This includes money spent on areas such as room rent, surgeon charges, nurse charges, and doctor’s consultation, to name a few.

These policies also provide coverage for post- and pre-hospitalization expenses. Apart from the difference between OPD and IPD, this is something that you should know as well. In a lot of medical situations, you need medication and proper care before you are hospitalized for the same. The health insurance plans provide you coverage for such expenses. They also come with some great renewal options. In some of these plans, you can renew the policy as long as you are alive. This is a great option for you to have in these cases as that way you do not have to look for other options when you get old.

Also Read: How to get a Cashless Facility for Daycare Treatments?

Difference Between OPD and IPD – In-Patient Department (IPD) vs Out-Patient Department (OPD)?

In-Patient Department and Out-Patient Department are two forms of treatment and there are several areas of difference between both. You already know what OPD and IPD stand for. In the case of IPD treatment, a patient must have been admitted to a medical facility for over 24 hours.

On the other hand, in the case of OPD, the patient need not be admitted for over 24 hours. If a patient comes to a hospital for treatment, they would first be visiting the Out-Patient Department area. A patient would only be admitted for IPD if the doctor asks for it. This is perhaps the biggest difference between IPD and OPD. Apart from that, OPD treatment is availed for consultation, dental procedures, minor surgeries, and ophthalmic procedures. On the contrary, if you are getting IPD treatment it means that your condition is serious enough to warrant hospitalization.

This includes complex and major surgeries, childbirth, serious illnesses where you have to be monitored at all times, and rehabilitation services, to name a few. So, now it can be assumed that you have understood the difference between Out-Patient Department and In-Patient Department. Apart from these, your chances of visiting a hospital for OPD treatment are much higher than that of the IPD. In any case, it helps if you have sufficient coverage in these cases, it will make sure that you and the people you love and care for get the treatment they need when they require it. IPD treatment is included in these policies, but OPD tends to be optional.

Also Read: Does Health Insurance Cover Infertility Treatment?

Health Insurance Coverage Under Out-Patient Department (OPD) 

Under OPD coverage of your health insurance policy, you can file claims for expenses incurred for treatments/procedures that don’t require hospitalization. So, it includes routine check-ups, follow-ups, diagnostic tests, pharmacy expenses, and minor surgical treatments. Overall, OPD treatments do not require hospital admission. OPD charges can be claimed within 90 days of purchasing a health insurance plan. A policyholder can make multiple OPD claims within an active policy year.

Health Insurance Coverage Under In-Patient Department (IPD)

Under the IPD coverage of your health insurance plan, you can incur expenses for procedures like hospital room rental, operating room charges, ICU costs, doctor fees, charges for anesthesia, nursing fees, and more. Here, the procedures/treatments require hospital monitoring for complex procedures and surgeries. It also requires the insured to be hospitalized for at least 24 hours.

If the insured gets the treatment in a network hospital of the insurance company, a cashless claim can be filed. If they prefer a non-network hospital for the treatment, the payment needs to be made by the insured/policyholder at the time of getting discharged from the hospital. Later, the insured can raise a claim for the same with the insurer.

Claim Resolution Procedure for OPD & IPD

In case of settlement of claims raised for both OPD and IPD treatments respectively, there are two separate procedures in place. They are detailed below for your better understanding:

• Cashless claim resolution: This is the simplest and by far the most convenient process for settling claims. All you need to do is show your e-health insurance card at the hospital during either IPD or OPD treatments. Upon presentation of the card, the hospital authorities would begin processing of the cashless claim, while you can proceed with receiving the appropriate treatment and OPD care at the hospital without worrying about the finances. Cashless claims can easily be made at any network hospital or day care centers.
• Reimbursement claim resolution: Unlike in cashless claims, here the patient is required to complete the IPD or OPD treatment at the hospital or day care facility and then raise a claim for reimbursement of the expense incurred from the insurer. In this case, the patient would have to first settle payment of the entire amount at the time of discharge and later upload all the required bills and relevant documents pertaining to the treatment expenditure for reimbursement.

Step by Step Claim Resolution Procedure for OPD & IPD?

Both IPD and OPD procedure requires a series of steps to complete the claim resolution and coverage reimbursements. Here are the steps to follow for the claim procedure:

Claim Resolution Procedure for OPD

Here are the steps:

Step 1 – Undergo the OPD procedure prescribed by the medical practitioner including diagnosis, tests, and treatment

Step 2 – Keep all the records of the treatment including bills, prescriptions, receipts, invoices, etc.

Step 3 – Download the claim form from the website of the insurance company and duly fill out the form

Step 4 – Here, you must attach all the documents that you have saved as mentioned in step 2. Also, any other document asked by the insurer (If required)

Step 5 – Next, submit the claim form along with the documents to the insurer

Step 6 – The insurer will review and verify your documents and the claim made by you

Step 7 – Once reviewed and approved, your claim will be processed and the insurer will estimate the reimbursement to be done as per your policy terms

Step 8 – Finally, your insurance company will reimburse the amount to your account, or pay the hospital directly

Claim Resolution Procedure for IPD

Step 1 – Undergo the IPD procedure or treatment as prescribed by the medical practitioner like surgery, hospitalization, etc.

Step 2 –Inform your insurer soon after or (if possible) before getting admitted to the hospital

Step 3 – Go through the process of pre-authorization with the insurer and complete it

Step 4 – Undergo the treatment during hospitalization

Step 5 – Next, keep the required documents from the hospital like bills, reports, and invoice summaries at the time of discharge.

Step 6 – Fill out the form of claim settlement and submit it along with the documents gathered

Step 7 – The documents will go through the process of verification

Step 8 – Once the claim is approved, the insurer will reimburse the expenses incurred for the treatment in case of reimbursement claims.

If it is a cashless claim, the insurer will take care of the procedure and make the payment of the bills directly to the hospital.

OPD and IPD Management Using HIMS

With the rapid growth in healthcare services, hospitals are increasingly becoming dependent on a technological innovation called Hospital Information Management Systems or HIMS. It has been designed to essentially optimize various IPD and OPD processes so that patients can be delivered the best care and services without wasting any time and also all the work carried out at different departments in a hospital can be streamlined.

Benefits of OPD Management Using HIMS

Some of the OPD processes that can be greatly optimized and managed effectively using HIMS include:

• Maintenance of health records of all the patients for quick reference
• Accurate diagnosis of all health conditions
• Billing and appointment scheduling
• Issuance of e-prescriptions
• Supervision of doctors/physicians from a single platform

Benefits of IPD Management Using HIMS

The IPD processes which HIMS helps with are:

• Preparation of discharge summary
• Management of beds and allocation of the same to patients
• Registration process during patient admission
• Billing and preparation of reports

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