Pre & Post-Hospitalization Claim Process
These refer to the medical expenses incurred before admission and after discharge — which are often covered by health insurance (for a specific number of days, like 30/60/90 days depending on your policy).
1. Pre-Hospitalization Expenses
What it means:
Expenses incurred for diagnosing or preparing for the treatment/hospitalization.
Examples:
Doctor consultations
Lab tests (blood tests, X-rays, MRIs, etc.)
Medications prescribed
Investigations or medical reports
Coverage Duration:
Usually 30 days before hospitalization (check your policy)
Claim Process (Usually Reimbursement):
Get hospitalized for the condition related to those expenses.
Collect all bills, prescriptions, and reports with dates.
After discharge, submit all documents to the insurer/TPA.
The insurer will verify that these are related to the illness for which hospitalization occurred.
Reimbursement is processed (usually within 15–30 days).
2. Post-Hospitalization Expenses
What it means:
Follow-up treatment expenses after discharge.
Examples:
Follow-up doctor visits
Physiotherapy sessions
Medications
Diagnostic tests to track recovery
Coverage Duration:
Usually 60 to 90 days after discharge (based on your plan)
Claim Process:
Keep all bills and prescriptions post-discharge.
Ensure they’re dated within the covered period and related to the same illness.
Submit these along with the main hospitalization claim or as a separate reimbursement claim.
Reimbursement will be made as per policy terms.
Documents Required (for both):
Original bills + payment receipts
Doctor’s prescriptions
Diagnostic reports
Hospital discharge summary
Health card copy
Claim form (if required by TPA)
Important Points:
These claims are reimbursement only (not cashless).
Only valid if the main hospitalization claim is approved.
All expenses must be medically necessary and linked to the same illness/treatment.