Inpatient vs Outpatient. What’s the difference?

We know that any medical admission can be daunting. It’s often hard to decipher the terminology used when referring to your admission or how we pay for your treatment.
At RT Health we’re committed to taking the jargon out of private health insurance.
We want our members to understand their cover, the benefits of private health insurance and some tricky terms when it comes to making the most of your cover. 
It’s often confusing … and it doesn’t need to be. 
We often field questions from our members who want to know "what is outpatient" vs being an 'in-patient', and how it impacts their treatment and their cover.
Essentially, you become an ‘inpatient’ when you’re formally admitted to a hospital for treatment. You’re an ‘outpatient’ if you receive medical services without being admitted into hospital.

 

What’s an in-patient? 

An inpatient is admitted to hospital for a medical treatment or procedure. 
Depending on the purpose of your hospital stay, there are different types of hospital admissions(inpatient medical services) including: 

• emergency (unplanned)
• overnight or extended (planned)
• maternity (planned)
• day procedure (planned). 

It’s not necessary to stay overnight to be classed as an in-patient. If you are admitted by a doctor and receive treatment you can still be an in-patient, even if it’s only for a few hours.

What does being ‘admitted’ mean? 

You’re admitted to hospital if and when your doctor decides there is a need for inpatient care (another way to understand inpatient meaning).
If you’re seriously unwell or injured, you may be immediately admitted to hospital through an emergency department. This is called an emergency admission. 

The other way of being admitted to hospital is a planned admission. It’s when your doctor refers you to a specialist doctor and the specialist recommends you be admitted to hospital for treatment. This generally doesn’t happen straight away and there are often waiting lists for surgery and other treatments. 

Types of In-patient 

PLANNED ADMISSION

If your hospital admission is planned, how you’re admitted depends on whether you’re going to a public or private hospital, how urgent your treatment is and the kind of treatment you’ll be receiving. 
Once you’re admitted into hospital, you’ll stay in a hospital ward. How long you’ll stay depends on the treatment you need. For minor procedures, you may only need to stay for a day, but for ongoing treatment or major surgery, you’ll need to stay for longer.

URGENT ADMISSION 

When you arrive at hospital in an emergency, either by your own transport or in an ambulance, this is called an ‘unplanned presentation’. 
If your condition is unexpected and you need urgent treatment, you’ll be admitted through the emergency department on arrival at hospital. This is done through a process known as ‘triage’. 
It’s important for members to know that we’re only able to pay benefits once you’ve been admitted as a patient. Private hospital emergency departments often issue invoices know as ‘facility fees’ and unfortunately we’re not able to pay them on your behalf. 

What’s an outpatient? 

You’re an ‘outpatient’ if you receive medical services or treatments without being admitted into hospital. This includes a range of procedures, from specialist appointments, post-surgical follow-up consultations, prenatal visits, diagnostic imaging, pathology, or emergency triage. 
When you’re treated in an emergency department, you’re an outpatient unless you are formally admitted into the hospital for further treatment or observation. 

What is Outpatient Services?

• medical treatment in a doctor’s surgery
• consultations at a specialist’s clinic or their rooms at a hospital
• treatment in a hospital emergency room
• diagnostic services such as pathology, X-rays, ultrasounds and other organ imaging.

Just because the treatment is happening at a hospital, it doesn’t mean you’ll be admitted as an inpatient. For example, doctors can conduct outpatient treatments at their offices in a hospital or at a medical centre for things like X-rays, chemotherapy, injections, wound dressings, skin treatments, home nursing, non-PBS prescriptions and prenatal classes. 

Why can you claim for inpatient services and not outpatient services? 

Unfortunately, Australian health funds can’t cover the costs of outpatient services or administrative fees. 
You’ll be covered by Medicare for most outpatient treatments, including things like GP visits, specialists’ consultation fees, X-rays and pathology. There are sometimes out-of-pocket costs for these services. 

Questions? 

We’ve got answers. 
We know that navigating treatment types and costs can often be stressful. Let us help you. 
If you’re unsure about what is and isn’t covered by your health cover, just get in touch. We can help break down your treatment and expected costs for you.

You can call our friendly team us on 1300 886 123 (Monday to Friday, 8:30am-5:00pm AEDT/AEST) or reach out via email to help@rthealth.com.au
We’ll be happy to help.