Health Insurance: Inpatient vs Outpatient Treatment

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Difference Between Inpatient and Outpatient Treatment

Inpatient and outpatient treatment are the two key components of medical treatment.

Most Private Health Insurance covers inpatient treatment in full as standard (subject to your policy’s terms).

Outpatient treatment which includes diagnostics and consultations isn’t typically covered on the most basic basic policies and is often an additional option for a much more comprehensive plan.

If you choose to add outpatient cover to your plan you’ll generally be given the option of adding a limited amount of outpatient cover or full outpatient cover. Opting for the latter means all outpatient treatment is covered (again subject to your policy terms).

What is Inpatient Treatment?

Inpatient cover refers to any treatment where you need a hospital bed overnight, such as after a surgical procedure.

For minor surgical procedures, you might be covered on a day-patient basis, where you need a hospital room but are discharged the same day of the procedure without spending the night in that bed.

The cost of inpatient treatment is made up of factors including:

  • Catering, the hospital room itself and related amenities (‘hotel costs’)
  • Initial blood tests and other checks to ensure you’re fit and well for the procedure
  • Fees for the medical and hospital staff (e.g. surgeons, anaesthetists, nurses, porters)
  • Fees for the medical care itself (e.g. the operation, drugs required during the operation etc.).

What is Outpatient Treatment?

Outpatient treatment refers to any diagnostics, consultations or treatment where a hospital bed is not required. It will often begin from an initial investigation following a referral from your GP and can be for a consultation involving blood tests, x-rays, MRI scans and so on.

Outpatient treatment may lead to a diagnosis of a condition that requires further treatment, such as a referral for further outpatient appointments, such as physiotherapy or chiropody.

However, often the initial diagnosis is that the patient requires surgical intervention, which will be inpatient treatment.

Why Add Outpatient Cover to Private Health Insurance?

Choosing a more basic PMI policy (inpatient-only) will allow you to get cheaper premiums. However, you’ll be sacrificing your level of cover which might mean no outpatient cover at all.

If you don’t opt for outpatient cover, then you’ll have to wait for the NHS for diagnostic tests before being referred for private inpatient treatment if necessary.

If, however, the results of the diagnostic tests you’ve waited for on the NHS require more outpatient treatment – e.g. physiotherapy – you’ll again be subject to NHS waiting lists.

Ultimately, you should be aware that having no outpatient cover on your policy could result in a delay in your care.

Reducing the Cost of Private Health Insurance Without Sacrificing Outpatient Care

There are options for finding cheaper Medical Insurance other than opting for inpatient-only cover. These include:

  • Adjusting Your Excess
    A Health Insurance excess is the initial amount you agree to pay towards your treatment before the policy kicks in. The higher your excess, the lower your premiums, but be careful to ensure your excess is affordable.
  • Limiting Your Hospital List
    Most providers have ‘tiers’ of hospitals you get access to with the policy. These range from private wings of NHS hospitals all the way up to world-leading Central London facilities. Limiting the hospitals you’re eligible to be treated in to cheaper facilities can reduce the cost of your cover.
  • Implementing a 6 Week NHS Wait
    This means your Health Insurance policy only kicks in if the treatment you need has a waiting list of more than 6 weeks on the NHS. If the waiting list is longer than 6 weeks, you’ll be able to receive private treatment as normal. If it’s shorter than 6 weeks, you’ll need to use the NHS.
Joseph Toft Health & Wellbeing Expert at Drewberry

Note that the 6 week NHS wait only applies to inpatient care. This means if you’ve added outpatient cover to your policy, you’ll be seen for all diagnostic tests / scans etc. privately as soon as possible. The 6 week NHS wait only kicks in when it becomes apparent you need inpatient care.

Joseph Toft
Health & Wellbeing Expert at Drewberry

Looking for Expert Private Health Insurance Advice?

To make sure you’re getting the Private Health Insurance cover you’re looking for, why not give our experts a call on 02074425880?

We’ll be able to talk through the huge variety of options available for you and help you make an informed decision.

With a vast array of choice in terms of providers of private medical treatment, choosing the right provider and plan that suits your needs is becoming more and more difficult.

Nadeem Farid Head of Employee Benefits at Drewberry

With our expertise at Drewberry we can help you by identifying what are the most important needs for you and tailor a plan that best fits in with your needs. Pop us a call on [dynamic number] or email

Nadeem Farid
Head of Employee Benefits at Drewberry

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