Are Day Surgeries Covered by Health Insurance?

What is day surgery?

Day surgery, also known as outpatient surgery, day-patient surgery, day-case procedure, ambulatory surgery and same-day surgery, is surgery that does not require the patient to be hospitalized overnight.

Thanks to advances in medicine, a growing number of surgeries and medical procedures can now be completed on a day-patient basis, allowing patients to save on hospital room and board fees and recover in the comfort of their own homes. Day surgeries can be performed at healthcare facilities connected to hospitals, standalone day procedure centers, or your doctor’s office.

Outpatient surgeries tend to have the following attributes: pre-scheduled, performed by a specialist in a procedure room or operating theater, minimal blood loss expected, low risk of complications, no specialist aftercare required, recovery and pain management can be done at home, and the patient can move around after.

What is a day procedure center (DPC)?

Day procedure centers in Hong Kong are licensed by the Department of Health.

The Office for Regulation of Private Healthcare Facilities defines a day procedure center (DPC) as “any premises that are used by registered medical practitioners or registered dentists for carrying out scheduled medical procedures on patients without lodging. The period of continuous confinement for patients must be within the facility for not more than 12 hours. Also, the continuous confinement for any patient must be within the same calendar day.” Additionally: “A DPC does not form part of the premises of a hospital.”

How to find a day procedure center

To find a licensed day procedure center, you can search the Private Healthcare Facilities Register. Currently, there are over 260 day procedure centers in Hong Kong.

Beware: Some “medical aesthetic centers” that offer surgical services may not be licensed. You can use the register linked above to verify if a facility is officially licensed.

Day surgery and outpatient procedure examples

The following are all examples of surgical procedures that can be done in an outpatient setting:

• Wart removal

• Cyst removal

• Incision and drainage of large abscess

• Cataract surgery

• Sclerotherapy (for varicose veins)

• Septoplasty (for a deviated septum)

• Colonoscopy

• Termination of pregnancy

• Arthroscopy

• Laparoscopy

• Vertebroplasty/Kyphoplasty (for spinal compression fractures)

• Hip and knee arthroplasty

• Rotator cuff repair

• Myringotomy (eardrum surgery)

• Wisdom teeth removal

• Adenoidectomy

• Tonsillectomy

• Cosmetic surgery

• Vasectomy

• Myomectomy (uterine fibroid removal)

• Hemodialysis

What happens in a day surgery?

For day surgeries, the patient is admitted to the hospital, clinic, or medical center for a few hours to undergo treatment, then discharged and sent home to recover with medication and dressings on the same day.

You may be asked to fast before your surgery (for instance, if you will undergo general anesthesia). Be sure to follow the instructions from the medical staff about any preparation you must do before.

It’s a good idea to bring a friend or family along with you on the day of your surgery. Not only can they help you get home safely afterwards, they can also help you remember any instructions you receive from the medical team. On the day of surgery, you may wish to arrive several hours before the scheduled time to fill out and sign forms and submit information from your insurance provider (including a guarantee of payment and pre-authorization letter). You might undergo some examinations and interviews before the procedure.

Depending on the type of surgery you have, you may be given some form of anesthesia to protect you from experiencing pain during the procedure. Once the procedure is complete, the anesthesiologist might monitor your condition for a few hours before determining that you can be discharged.

Before discharging you, the medical team will probably give you instructions, medication, and extra dressings to take home. Once you’re at home, try to have someone stay with you over the next 24 hours (at least) in case you need assistance during this immediate stage of recovery.

Take it easy after your procedure. It may take you several days before you feel normal again.

Is day surgery covered by insurance?

Barring policy exclusions and moratoriums and waiting periods, health insurance plans do cover day surgeries. In fact, many insurance providers – local and global alike – have developed day-patient benefits in their plans.

Day-patient benefits are usually listed under inpatient or hospital benefits. If your surgery takes place in an outpatient setting, as in the cases of cataract surgery or a colonoscopy, it might be listed under outpatient surgery or outpatient procedure benefits. You can review your policy documents for the exact details or ask your insurance advisor for help.

Whether you’re undergoing a day-patient or inpatient surgery, it’s a good idea to contact your insurance advisor or agent beforehand to confirm coverage. If your insurance company agrees to cover the procedure, they will get in touch with your hospital to validate the procedure and costs and grant pre-authorization.

They will also set up a guarantee of payment (GOP), whereby the insurer pays the hospital or clinic directly so you don’t have to handle any payment or paperwork. Note that the pre-authorization is a preliminary assessment and might differ from the final claim payment, which will be made according to the assessment of the hospital bill by the insurer’s medical board.

Read in depth: How to tell if your health insurance covers your surgery