Are Nursing Expenses Covered in Health Insurance?

 What Expenses are Covered Under Health Insurance?

When you buy a health insurance policy, the following expenses are generally covered under it:

• Emergency services

• Hospital expenses like surgery

• Ambulance service

• Maternity and new-born care

• Prescription drugs

• Mental health and substance use disorder services (inclusive of counseling and psychotherapy)

• Habilitative and rehabilitative services and devices

• Pediatric services

• Preventive and wellness services and chronic disease management

• Laboratory services

• Post-hospitalisation services

This would differ from policy to policy.

Claiming Nursing Expenses

When you buy a medical insurance policy, it covers the hospital and post-hospital expenses incurred for a defined number of days. This varies from one health insurance provider to another. If the hospital costs are for the same medical condition for which the insured individual was hospitalized, then the hospital charges incurred in a specified period is payable by the insurance company. The insurance company also admits the in-patient hospital costs claim.

You can claim the nursing expenses only if your health insurance provider has added nursing expenses in the post-hospitalisation expenses. Usually, medical insurance policies cover post-hospitalisation expenses related to consultation fees, diagnostic charges and medicine costs. But, if your insurer has added nursing expenses under the category, you can claim these expenses by submitting the original bills, doctor’s certificate, and a discharge summary to the insurer.

What if my insurance doesn’t cover a certain expense like that of nursing charges?

Usually, a medical insurance policy covers all the medical treatments recommended by a doctor. But, there might be a few exceptions in certain cases. If you have a test or treatment where hiring an attendant is necessary, the expenses of hiring an attendant or nurse may not be covered by your insurance policy. Such a situation can lead to ‘rejection of the claim’. Majority of the cases are subjected to this situation since many insurers don't cover nursing expenses. However, with the right to appeal the decision, you can still pursue your insurance provider to cover the expenses. Before that, you have to make sure that you are acquainted with the appeal process of your insurance company. The process will be discussed in your plan handbook.

Conclusion

It is always wise to be well-versed with your medical insurance policy to avoid the occurrence of such situations. Read the fine-print of the insurance policy thoroughly and ask necessary questions to your insurer while buying a health insurance. It is best to be well-acquainted with the policy coverage and claim process as that will help you in future.

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