Hassle-Free Health Coverage: Inpatient Care
Hospital inpatient care provides you with benefits for charges a hospital makes on its own behalf. For example, room and board, nursing care, etc. Most plans limit room and board to a semi-private room rate, a maximum dollar amount per day and a maximum number of days.
Say you have inpatient coverage with benefits of $300 a day for a maximum of 365 days. You're confined for 10 days in a private room. The hospital charges $325 a day for a private room and only $250 a day for a semi-private room. Your policy will only pay $2,500 -- the semi-private room rate for 10 days. You end up paying the difference.
Inpatient benefits can provide coverage for confinement for mental, emotional, or nervous disorders, alcoholism and drug dependency -- but not more than 30 days in any one policy year.
Confinement means that a policyholder is confined in a hospital or mental hospital for 24 hours or more and a daily charge is made. In order for a period of confinement to be covered, it must occur because of injury or sickness, begin while coverage is in force, and at the direction of a physician or surgeon.
Also, you might want to check with your plan administrator to see if your policy covers extended care facility coverage, or extra hospital miscellaneous expense coverage. These coverages are optional and provide an additional amount of insurance while you are an inpatient. Hospital intensive care unit coverage may also be covered.
The term one period of confinement is important because basic hospital expense policies usually limit the maximum benefit for each period of confinement to a number of days and a total dollar amount. In addition to a continuous period of confinement, multiple confinements due to related causes and separated by less than 180 days will be treated as a single confinement.
For example, you have an appendectomy and spend three days in a hospital. After release, the incisions become infected and you're readmitted 20 days later. For benefit purposes, both periods in the hospital related to the appendectomy are treated as a single confinement.
