Can you explain why OPD charges are relatively high for illness coverage?

Johnny, why do health insurance companies like BUPA and THI, and others, include outpatient (OPD) for accidents in their basic plan and then charge another 50% to 80% more to add very limited OPD coverage for illness?

Frivolous and unnecessary usage of outpatient (OPD) care for illness is much more difficult to control than inpatient (IPD) care and emergency OPD care for accidents are; and providing it can be very costly to insurance companies.

Both BUPA and THI, therefore, charge more to include OPD coverage, limit the number of doctor visits per year, and put a low ceiling on the amount they will pay per visit.

By contrast, getting admitted to the hospital for IPD care requires the signature of a qualified physician on a form stating the need. While qualifying for emergency accident OPD care, of course, requires an accident to happen and some sort of trauma to the body to occur.

Anyone with insurance that has limited or no OPD coverage for illness who visits the doctor often with the same complaint, and receives only temporary relief for that complaint, should request to be admitted to the hospital for more thorough testing and observation. All it takes is a 6 hour stay in the hospital to qualify for payment under the IPD coverage.

Back to the Health Insurance FAQ



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