Does Insurance Cover Hospital-Acquired Infections?

HAI's can be responsible for longer treatment and longer hospital stays. They can be acquired after surgery, following a stay in the intensive care unit, or after using a catheter. Typically, these infections are covered by health insurance if they occur during a medical necessity. Meanwhile, the insurance companies impose restrictions and exclusions as per the policy terms.

Coverage for Hospital-Acquired Infections

Covers Treatment During Hospitalisation

Most health insurance plans cover the treatment of infections that occur while you are in a hospital that has been approved by the insurance provider. Antibiotics, IV fluids, oxygen, and/or more monitoring may be needed to manage the infection.

Covers Extended Hospital Stay

Hospital-acquired infections can often be a source of delayed recovery. If physicians recommend that the patient remain for treatment and observation, insurance companies typically will continue coverage.

Covers ICU and Critical Care

Very severe infections can cause sepsis, pneumonia, or organ involvement. ICU care, ventilator support, and critical care costs are typically covered by a hospital insurance policy up to the limits of the policy.

Covers Surgical Site Infections

Sometimes patients get infections following surgery. If the original surgery is covered by an insurance plan, the insurance company typically will cover the treatment cost as well.

Covers Diagnostic Tests

Blood tests, cultures, scans and infection tests are used to determine the source of the infection. Most insurers will cover these diagnostic costs in the hospital treatment.

Covers Medicines and Medical Consumables

Prescribed anti-bacterial, anti-fungal medicine, injections, and hospital consumables are normally covered by insurance plans during treatment.

Covers Pre and Post-Hospitalisation Expenses

Several policies also contain follow-up consultations, medications, and diagnostic tests prior to and following discharge. Patients can benefit from these services without having to handle all the costs themselves.

Offers Cashless Treatment at Network Hospitals

Most underwriters offer a cashless claim option at network hospitals. This competes with the ability for patients to get immediate treatment without having to book large upfront payments.

Limitations and Exclusions

Insurers Apply Policy Limits

Depending on the sum insured, room rent limit, ICU limits and co-payment terms. Treatment can be lengthy and incur hospital costs in excess of policy limits.

Waiting Periods May Affect Claims

Those who already have certain medical conditions, such as diabetes or kidney disease, may have to wait longer for full coverage of their diabetes or kidney disease-related complications.

Some Policies Exclude Non-Medical Expenses

Personal expenses, special nutrition, attendant costs and non-prescribed supplements may not be covered.

Experimental Treatments May Not Receive Coverage

Unapproved or experimental infection therapies that are not part of normal medical care are often not covered by insurance companies.

Network Hospital Rules Can Affect Reimbursement

If the patient elects to use a non-network hospital or does not adhere to claim procedures, they may receive lower reimbursements.

Final Thoughts

Most health insurance policies would cover hospital-acquired infections that are present during medically necessary treatment. However, policy restrictions, exclusions, waiting periods, and claim conditions may impact the actual settlement amount. By reading the policy carefully, patients will be able to understand its benefits and restrictions before a medical emergency.