Guide
The difference between in-patient and out-patient cover
What is in-patient care?
When getting health insurance, it's useful to know the difference between in-patient and out-patient care. It will help you decide which type of health insurance cover you need.
You’re called an in-patient when you’re admitted to a hospital or healthcare setting for at least one overnight stay. This is usually because you need specialist care that can’t be provided in a few hours as an out-patient.
Procedures, such as surgery and treatment for cancer and heart disease, will usually need a stay in the hospital as an in-patient. Your hospital stay may be planned in advance, but you can also be admitted as an emergency.
Examples of in-patient care
Most major surgery will involve an overnight stay in the hospital. Heart surgery, hip and knee replacements all require recovery time. And you may need rehabilitation or physiotherapy before you’re allowed home.
Other examples of in-patient care include:
- complications with pregnancy
- severe infections that need intravenous antibiotics
- major injuries.
You’ll need to be closely monitored during your recovery which means time spent in hospital.
You may also need to spend time in hospital following a cancer diagnosis. This allows your cancer care team to monitor your health and agree a treatment plan. With some cancers you can then have your treatment as an out-patient.
Does health insurance usually include in-patient cover?
Most comprehensive health insurance plans will include in-patient cover. So, you’re likely to be covered if you need to go into hospital. In-patient stays typically need to be planned at least 24 hours in advance.
Usually, all your medical costs will be covered. These include:
- diagnostic tests, including pathology, radiology, and CT, MRI and PET scans
- your surgeon and anaesthetist fees
- nursing costs and consultant appointment fees
- your hospital accommodation costs
- operating theatre charges
- any surgical appliances, dressing and drugs needed
- post-operative physiotherapy and rehabilitation as an in-patient.
When you make a claim, your provider will explain what’s involved and what’s covered. Most providers will have a list of approved hospitals they use and will expect you to be treated at one of those. You may also need to pay to pay any excess on your plan before you go for treatment. An excess is an amount that you pay towards your medical treatment before your insurance picks up the rest of the cost.
In-patient cancer cover varies between providers. Some insurance providers offer full cover for all cancer surgery and reconstructions. So it's important to make sure you’re clear about the extent of your cover before you take it out.
What is out-patient care?
As an out-patient, you will be covered for appointments with a consultant and any diagnostic tests they order, when you don't need to be admitted to hospital. For example, some minor surgeries and physiotherapy do not require you to be admitted to hospital, as they may only take a few hours, meaning you can return home the same day.
This type of care usually takes place in a hospital, but it can also be in a clinic or doctor’s office.
Examples of out-patient care
Out-patient care covers a wide variety of treatments, tests and appointments. It includes:
- visits to your GP
- consultant appointments
- diagnostic tests, such as x-rays, blood tests, CT, MRI and PET scans
- minor surgical procedures
- physiotherapy
- routine health screening.
Does health insurance usually include out-patient cover?
Most health insurance plans won’t cover you for all out-patient care as standard. But insurers usually offer out-patient care as an optional extra.
Some insurers, will include out-patient surgery in their core health insurance. But if you need diagnostic tests, you’ll need to take out extra cover or refer back to the NHS.
If you take out optional out-patient cover, you can usually choose how much cover you want. For example, you can choose a cover limit from £500 to £1,500. You can spend it on out-patient consultations and diagnostic tests. Or if you want full cover for both, that’s also an option.
Some types of cover will also pay for additional physiotherapy treatment. This means you can carry on with your private treatment even after using up all the sessions in your core cover.
It’s important to keep an eye on the costs of any out-patient treatment. When you reach your cover limit, you’ll need to pay to continue private treatment. Your plan details will explain the level of cover you have.
What determines if you need in-patient or out-patient care?
Your GP or Consultant will determine whether to treat you as an out-patient or admit you as an in-patient. They’ll look at how severe your condition is and whether there may be complications. They’ll also consider your general health and health history.
You’re likely to need in-patient care for major surgery. This includes serious infections and some cancer treatments. But for minor surgery, physiotherapy and some ongoing cancer care, you can be treated as an out-patient.
What is the difference in costs between in-patient and out-patient care?
In-patient care tends to be much more expensive than out-patient care. Because you’re likely to have a serious condition that needs intensive treatment. You should expect to be charged for:
- consultant and nursing fees
- accommodation
- surgical dressings
- medication
- any rehabilitation needed.
And if you need surgery, add on the cost of the procedure and the anaesthetist fee. For an operation like a hip replacement, patients can expect to pay an average of £13,402.1
By taking out private health insurance, you’re insured if you need in-patient care. As long as the insurance company approves your treatment, they’ll pay the cost of your in-patient care. You may need to pay an excess if there is one on your policy.
In contrast, private out-patient care is generally less costly. You’re usually only charged for the specialist’s time and any medication you may need.
But, not every private health insurance policy covers out-patient care. This means that if your virtual GP refers you for private out-patient tests, you may have to pay for them.
Should I add out-patient cover to my policy?
First of all, check with your prospective insurance company. See if they provide any out-patient cover with their core plan. If they don’t, they probably offer it as an optional extra.
You’ll need to pay more for this extra cover, but it could be very worthwhile. You are more likely to need a minor procedure or physiotherapy than serious surgery. And if you add out-patient cover, you’ll be insured for both just in case.
One significant benefit to out-patient cover is being able to get scans and diagnostic tests quickly. Most standard health insurance won’t pay for private tests unless you're an in-patient. This means that as an out-patient, you may need to wait until there’s an NHS appointment.
Another benefit is being able to continue with your recovery privately after you come out of hospital. With out-patient cover you can carry on with your rehabilitation at a time and place that suits you.
Take time to weigh up the cost of additional cover against the convenience of having it in place. Remember that you can choose the cover limit that suits your budget. And it’s possible to return to NHS care at any time. A personalised quote can give you a clear idea of cost.
Why choose Vitality?
Our Core Cover includes all eligible in-patient procedures, as well as out-patient surgical procedures. But you can also get extra Out-patient Cover by adding other Cover Options to your plan.
Vitality Out-patient Cover helps pay for:
- Diagnostic tests – MRIs, CTs and PET scans, blood tests, X-rays, radiology and pathology.
- Specialist consultations and consultant fees.
- Extra physiotherapy – That's on top of the six sessions you have with your Core Cover.
- All members with Out-patient Cover get full cover for MRI, CT, and PET scans.
Vitality private health insurance
Want to know more about health insurance or thinking about taking out a policy? Here are some of the benefits of taking out health insurance with Vitality:
- See a private GP within 48 hours
- Avoid lengthy hospital waiting lists
- Get specialist drugs and treatments
- See a consultant fast
- Refer yourself for physiotherapy
- Get mental support fast and without a GP referral
- Discounts from top brands. And rewards for getting healthy.
Published: 8 July 2024
1 Source: "Average Cost of Hip Replacement Surgery in the UK" (ProHealth Clinic, February 2024)
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