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When it comes to your health, it’s important not to get confused by jargon – and two terms that are thrown around regularly are 'inpatient' and 'outpatient'.
Not only do they mean two very different things, but knowing what’s what will help you determine whether you’ll be covered by Medicare or your private health insurance – or whether you’ll have to pay for the treatment out of your own back pocket.
An inpatient is someone who’s been admitted to hospital for medical treatment. The main two ways that you could become an inpatient is through a hospital’s ER (emergency room), or through a pre-booked surgery or treatment (like if you need a knee replacement).
You don’t have to stay overnight in hospital to be classified as an inpatient, so as long as you’ve been admitted by a doctor and received treatment, such as surgery or an endoscopy, even if you’re only in for the day – you’ll still be an inpatient.
It’s important to remember that even if you’re visiting your doctor or specialist at a hospital, it doesn’t necessarily mean you’re classified as an inpatient. Some medical professionals may have a room they work from within a hospital.
We spoke with nib’s Clinical Consultant, Shaun Bowden to help us understand the difference.
“Generally when you’re an inpatient, you’ll be checked into the hospital, given a hospital gown to change into, be provided a room or a bed and be asked to sign the National Claim form,” Shaun explains.
If you’re classified as an inpatient and choose to use the system as a public patient, Medicare will cover the cost of your in-hospital treatment for the duration of your stay.
If you’re eligible to use your private health insurance, you’ll be able to receive inpatient treatment as a private patient. In an emergency, you may be asked whether you’d like to be admitted as a public or private inpatient. It helps to understand the pros and cons for each option.
For more information, check out our article: Should I use my private health insurance in a public hospital?
The hospital or your doctor will let you know when you’ll be discharged – that’s when you’ll be able to leave the hospital. Once you’re discharged from being an inpatient, you’ll be classified as an outpatient.
You’ll be classified as an outpatient for any sort of medical treatment in a doctor’s surgery, specialist’s clinic or even in a hospital’s emergency room when you haven’t been admitted to hospital.
So, even if you’ve been previously admitted to the hospital as an inpatient, once you’re discharged, you’ll then be classified as an outpatient.
“If you’ve booked an appointment with a doctor or specialist at a hospital for a consultation or an injection with a bill to take to Medicare, you’ll probably be classified as an outpatient,” Shaun explains. Outpatient treatments can include things like X-rays, injections, wound dressings, skin treatments, chemotherapy, home nursing, non-PBS prescriptions, physiotherapy and pre-natal classes.
Some of these treatments can be partially covered by Medicare or your private health insurance Extras, but you’ll most likely have some out-of-pocket costs.
If you're an nib member heading to hospital soon, make sure you check out our Going to Hospital page. This tool gives you information on health insurance, tips on how to reduce any out-of-pocket expenses and helpful questions to ask your specialist. To find out the details of your current policy, chat to someone about your upcoming hospital visit or get some guidance, call us on 13 16 42.