Does your insurance policy offer OPD expenses coverage ?

Does your insurance policy offer OPD expenses coverage ?

With the increasing demand for health insurance plans providing a variety of options, people are more secure than they ever were! Hospitalization claims are easy to get and people have to no longer worry about the expenses of their medical care. Also, ‘hitting the doorbell’ of your physician or doctors has become more common due to an increase in lifestyle diseases and other health-related issues.

Insurance companies keep on changing their plans due to the dynamic nature of a customer and the environment. They bring changes in their health plans to meet the needs and demands of the insured. Apart from the hospitalization claims, customers can reach out to the companies for their coverage of other expenses as well. Let’s see what these expenses are and how to choose the right plan to cover them.

OPD Expenses

Whenever you visit a hospital, you might have seen or heard about an OPD department. You visit an OPD or Outpatient department to reach out to the medical practitioners in the hospital for consultation, treatment and diagnosis of your health condition. Patients do not have to be admitted or hospitalized in this case.

OPD Expenses

Expenses incurred for doctor’s consultation fee, pharmacy bills, health check-ups, etc, except for hospitalization are OPD expenses.

Some of the OPD expenses are:

  1. Doctor consultation
  2. Pharmacy bills
  3. Diagnostic tests
  4. Dental treatment
  5. Maternity check-ups

Coverage is available for OPD Expenses

Health insurance plans have started covering OPD expenses as well. This is beneficial for people as their day-to-day medical expenses can also be easily covered.

While choosing your health plan, you must go through your coverage and exclusions. If OPD expenses are covered in your policy, you will be put to a much higher premium with an exhaustive limit for such expenses, say for every month or year. Different insurance companies will give you different benefits. It's up to you, what you choose for yourself!

There are closed network and open network policies. Under a closed network policy, you will have to reach out to only a fixed network of doctors as per the policy. Under an open network policy, you can reach out to any doctor. Insurance plans come with several other benefits such as pre-hospitalization OPD expenses (about 30-90 days) and post-hospitalization (about 60-180 days) as well.

It is different from hospitalization claim

In this case, you won’t have to go through the hectic journey of being admitted to the hospital. Instead, you can easily carry your reports or any pre-consultation record and go to the OPD of the desired hospital or any clinic, make an appointment and there you are having a conversation with your doctor! Showing the desired documents to your insurer will get you a claim for the OPD expenses or reimbursement for the same.

Trust us, it is beneficial!

Paying consultation fees for doctors or diagnostic tests might not seem a lot in the short run. But slowly, these expenses can become a burden over you. Therefore, it is always beneficial to go for a health insurance policy that covers your OPD expenses along with an affordable premium.

Benefits of Health Policy


  • There is no waiting period for coverage of such expenses
  • You can apply for many claims within a year, depending on the limit of your policy
  • You don’t have to be admitted to a hospital in such cases
  • You don’t have to delay your diagnostic tests as they are covered in your policy
  • Optional OPD cover coverage is available

In short, you don’t have to wait to reach out to your doctor in case of any serious medical condition just because you are broke. Your health insurer will take care of that.

It is natural to feel perplexed while understanding your policy and go through its terms & conditions. But with the right amount of knowledge and your insurer’s help, you can always choose the policy which will provide you with maximum benefits.

What can we do?

ClaimTherapist can provide you with a range of services for a smooth claim experience. We can help you with discounted OPD expenses and provide you with a diagnostic network. We shall keep you on loop at each and every step of claim process.