Cost of medical treatment - monthly cap

[Gareth]

I recently read Ben's article on GaijinPot about being in hospital:

https://blog.gaijinpot.com/hospital-sta ... ou-expect/

The information about the "kogaku ryoyohi seido" (high cost medical insurance benefit), i.e. a cap on how much you need to pay for medical treatment, is good to know. Thanks for that. But I don't quite get how the monthly cap works.

Let's say you are going to be in hospital for 20 consecutive days, ten days of which fall in May and ten days of which fall in June.

Which is these scenarios is correct? I've used round numbers to simplify.

A: Receive a bill of one million yen at the end of May for the first ten days and pay 100,000 benefit charge. Receive another bill of one million yen in June when you leave hospital and pay another 100,000 benefit charge. That means you pay the benefit charge twice.

B: Receive one bill of two million yen for the whole 20 days when you leave hospital in June and pay 100,000 benefit charge, meaning you pay the benefit charge once.

If scenario A is right, that seems unfair to those who are admitted towards the end of the month and treatment is spread over two calendar months rather than those who are admitted at the beginning of a month and can complete their whole stay in one calendar month.

But if scenario B is right, then that makes sense!

Or is there scenario C?

[RetireJapan]

My understanding is that the cap only applies to calendar months. At the end of three months I believe you don't have to pay any more, so if you are in hospital for a long time your total expenses are also capped.

Doesn't make much sense to me. I guess if you have the choice, schedule your hospital stay so that it is confined to one month!

[captainspoke]

I wrote a longer reply and then deleted it. Basically, I wonder what would cost a million over ten days, and then cost another million for the successive ten days? I didn't pay that much for what was open heart surgery (plus some other ongoing treatment), and that was an eight week stay with a private room the whole time.

Also, what do you mean by "benefit charge"--what is the japanese for that? (sorry haven't gone back to review Ben's post)

About the only thing I can add is that, yes, when you stay in hospital over a calendar month break, they do ask that you pay the bill for that past month. But tho I did pay (a couple different cases), they were polite about it, framing it as a request ("it'd be nice if you could...") rather than a demand. In your 10 day + 10 day scenario, they might not even get around to asking before your second ten days is up--tho you would then pay it all on checkout. In my cases, they knew I would be in for the entire next month, not just ten days, so I'd guess they wanted to close out their monthly books.