Does Health Insurance cover diagnostic charges?

Understanding Diagnostic Coverage in Health Insurance Policies

A health insurance plan is mandatory for everyone irrespective of age, as it helps to cover the medical and surgical expenses of the insured individual or family.

Health insurance plans protect one from pre as well as post-hospitalisation expenses. In treating any critical illness, there is always a demand for a high-cost diagnosis process, including X-rays, MRIs, Ultrasound or invasive tests, etc. These expensive tests take a heavy toll on our finances.

Various types of health insurance plans are available in the market; it is challenging to understand the inclusions and exclusions in health insurance. We often get confused while deciding which type of plan serves our needs and purpose.

So, before purchasing any plan, we must go through the entire prospect to better understand what the insurance covers and what does not.

What are diagnostic charges?

Diagnostic tests are simple or advanced examinations done by medical practitioners to identify, screen, detect or monitor a person’s health and body to determine any illness, disease or condition. It is used to gather the necessary clinical information to start a diagnosis.

The diagnostic charges may vary for each test based on diagnosis equipment, process, method and type.
Some of the standard diagnostic procedures are

CT Scan (Computed Tomography)
MRI (Magnetic Resonance Imaging)
X-Rays
Ultrasounds
EMG (Electromyography)
ECG (Electrocardiogram)
Biopsy
Mammography
Blood tests
Colonoscopies
PET (Positron Emission Tomography)
Eye tests

These diagnostic tests may cost you from several hundred rupees to thousands; the cost depends on the nature of the tests you undergo. The diagnostic charges of pre and post hospitalisation which are in association with the in-patient hospitalisation will be covered under a Health Insurance Policy.

Are diagnostic test charges included in health insurance coverage?

The answer is YES; most diagnostic tests like X-Rays, MRI, and blood tests are covered under health insurance plans, but it varies from plan to plan. The diagnostic charges will be considered subject to it is relevant to the treatment done for the current hospitalisation.

The patient’s stay must be as per the health policy’s minimum stay duration. Diagnostic tests prescribed to OPD patients are generally not covered under health policy plans. Wherever there is a Government capping for the Diagnostic tests, the same shall be applied by the Insurer.

However, many health insurance plans have features where pre and post-hospitalisation charges are included. So, the insurer may cover diagnostic costs 30, 60 days before hospitalisation and 90/ 180 days after the discharge date, but it varies from plan to plan.

So, choosing the right comprehensive health policy for you and your family is needed to protect you from financial burnout.

How to choose a health insurance policy that covers diagnostic test charges?

As you know, there are various top insurance policies available in the market. It is necessary to understand the terms and conditions of each plan before purchasing any particular Health Insurance plan.

Does insurance cover a diagnostic mammogram?

Diagnostic mammograms are not covered by insurance in the same way as screening mammograms. As the screening mammograms used for preventive care are covered by many insurances. But as the diagnostic mammogram helps diagnose something, you might have to pay a copay or coinsurance based on your insurance policy. The diagnostic insurance coverage may not cover it.

Does medical insurance cover genetic testing? Does health insurance cover diagnostic tests?

Yes, many private health insurance policies cover genetic testing when the doctor makes recommendations. But not all the policies cover genetic testing.

Conclusion

Before buying a best health policy, it is essential to understand the inclusion and exclusions of the policy. Diagnostic tests like CT-Scan, MRI, and X-ray costs are high today; it is crucial to choose a comprehensive plan that covers the pre and post-hospitalisation expenses.

As discussed earlier, diagnostic tests are the first step of treatment used to identify the disease, illness or condition, and it can’t be avoided at any instance. A good health insurance plan will protect you from these unexpected expenses and help you save money from these medical emergencies.

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FAQ

Are diagnostic tests covered by insurance?

Yes, diagnostic tests are usually covered by health insurance, but it is based on the health insurance policy and the type of tests.

How does insurance affect healthcare costs?

Insurance helps with healthcare costs in many ways. Health insurance protects individuals and families from high medical costs. Not all; some insurances cover in-network health care, preventive care, and diagnostic tests. In many cases, insurance doesn't cover ultrasounds and other methods.

Define insurance diagnostic codes?

Insurance diagnosis codes refer to the codes used by insurance providers to make decisions on requests and claims. Those insurance providers use these codes to find out how much they should pay your healthcare provider when you claim.

Does insurance cover radiology?

Yes, many health insurance policies cover radiology, like X-rays, MRIs, and ultrasounds.

Is diagnostic fee covered by warranty of the insurance?

Whether the diagnostic fees are covered by an insurance warranty or not is based on the type of insurance and its other circumstances.

Does health insurance cover x rays?

Yes, many health insurance policies cover X-rays, but the specifications of coverage differ based on the plan and could depend on many factors.