Does Your Health Insurance Policy Cover the Cost for Home Treatment?

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Sometimes, the medical experts recommend home treatment for specific conditions. But, can you file a claim for treatment availed at home? Does health insurance cover home treatment costs? Read on to know more.

Home treatment, which in insurance is also known as domiciliary hospitalisation, is a situation where the health insurance holders are considered as hospitalised for treatment even when they are at home. Today, many health insurance companies cover the treatment cost of domiciliary treatment.

In the purview of the current COVID-19 situation, many doctors recommend home treatment for many patients, especially those who have mild symptoms or are asymptomatic. Also, owing to the shortage of beds at the various public healthcare centres, many people for home treatment. Depending on the terms and conditions of your health insurance policy, you can avail cashless claim facility or get reimbursement for the treatment.

Many health insurance providers offer home treatment coverage as an in-built feature, whereas some providers offer the coverage as an add-on cover. And, since the coverage is not a standard or a mandatory feature in the health insurance policies, the coverage provided may differ from one insurer to the other.

How does domiciliary hospitalisation cover work?

Although domiciliary hospitalisation is nowadays relevant mainly for the COVID-19 patients, the coverage can be availed for treating other diseases. You may avail of this facility under different circumstances.

Home treatment implies that the insured person needs hospitalisation, but it’s not possible because of the following reasons:

  • There is a shortage of beds at healthcare facilities
  • The patient is weak or has certain conditions due to which they cannot come to the hospital.
  • The doctor specifically prescribes home treatment.

What treatment costs are covered under the home treatment?

Now that you know how the home treatment coverage works let us look at the expenses covered under this facility. Generally, all the costs covered under hospitalisation are covered in domiciliary hospitalisation, including doctor consultation fees, medicines, diagnostic tests, etc.

How to file a claim for home treatment?

The claim process for home treatment is similar to the process for in-hospitalisation treatment. You must keep all the treatment-related documents, including bills, prescriptions, investigation reports like CT scan, X-ray, blood tests, etc., so that you can submit the same along with the claim form for a hassle-free claim experience.

But, before you submit the bills to underpin the claim amount, you must inform the insurer or the TPA (Third-party administrator) about your condition and the treatment you receive as soon as you are diagnosed with the illness. After the treatment is over, you must submit the proofs to the insurer for verification.

If you have opted for a cashless claim, the insurer will settle the bill directly with the hospital as per the policy terms after the verification is over. If you file for reimbursement, the insurance company will repay the expenses incurred after considering the deductions.

Final Word

Most of the health insurance policies in India cover the home treatment cost. However, you must be aware of the policy terms and conditions to ensure that you don’t face any hassles during the claim process.