What is the difference between Inpatient & Outpatient?

Inpatient and Outpatient cover are two common terms you will come across when taking out private medical insurance. Most health insurance policies cover inpatient treatment in full as standard.

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Inpatient Cover

Inpatient cover is any treatment where you need a hospital bed overnight (usually following surgery). However, more minor procedures where you need a hospital room but are discharged the same day are called day-patient. Day-patient procedures will be included in your inpatient cover.

Outpatient Cover

Outpatient cover refers to diagnostic tests, consultations and procedures that do not require a hospital bed overnight. Things such as blood test, X-rays, MRI and CT scans are all examples of outpatient treatments. You can tweak your outpatient cover to make your plan more basic or comprehensive. This is done by excluding outpatient cover or adding a limited or full amount.

Many providers also offer outpatient surgery in full if an outpatient option is selected, out patient surgery can be anything from minor surgeries such as wart removal to an endoscopy.

FAQ's

  • Fees for the operation and any drugs required
  • Fees for medical staff (surgeon, anesthetists, nurses etc.)
  • Pre-surgery checks
  • Private recovery room, facilities and catering

Many of our clients express that speed of treatment is a major reason they have private medical insurance. If this is also a key deciding factor for you, then we would recommend having a reasonable level of outpatient cover. As a result, this will allow you to bypass the wait on the NHS for diagnostic test and start treatment quicker.

In our minds there are 4 levels of outpatient cover you can opt for;

1) None –  however most providers still have cover for MRI, CT and PET scans as an outpatient.

2) Capped Outpatient cover – this is where a provider will cover “£x” amount of outpatient benefit and will usually cover MRI, CT and PET scans in full. The amounts offered are between £500-£1,500 depending on provider. It is worth noting that capping your cover in this way can lead to you having to fund some tests, scans or consultations yourself as in practice even the £1,500 limit may not go that far if for example several consultations, blood tests and lets say an ultra sound is required.

3) Capped with full diagnostics – this is where an insurer will only cap the number of consultations they will pay for but will cover ALL diagnostic tests in full. Strangely it is priced at very similar point, in some cases cheaper than option 2 even thought the cover is greater. Ultimately we would like to think that all insurers will start offering this as an option as it is very popular but currently only offer by 3 providers, AXA PPP, Health-on-Line and VitalityHealth.

4) Full Outpatient Cover – this is exactly what it sounds like, there are no limits for consultations or diagnostic tests. This is the most expensive option you can select as it is the first point of call for most claims. 

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