In the financial services area, consumer courts receive the largest number of complaints on medical insurance claims.
Complaints are largely on account of underpayment or even rejection of claim payments by health insurers. Considering that events leading to health insurance claims themselves are stressful, any issue with the insurance compensation only adds to the stress.
Industry experts say there have been some common misses by customers while making a claim. Let’s look at what you need to do to ensure a hassle-free health claim.
PAPERWORK
INSUFFICIENT documents are some of the most common causes of a dispute. Insurers ask for original bills and documents to ensure that customers do not make multiple claims. Also, you have to submit a document called discharge summary, which adds to the authenticity of your claim.
He says the simple logic is that every outgo has to be supported with an authentic document, which justifies the expenditure. For example, if you claim for consultation receipt by the doctor, then you have to submit the prescription along with the claim form.
Similarly for diagnosis, you have to submit the diagnostic report and medical reports such as X-rays and scans for an operation. Similarly, medical bills have to be numbered. Just a list of medicines on a clinic’s letter head or with a rubber stamp will not suffice. In fact, the list of documents you have to submit is mentioned on the reverse of the claim form or any of the third-party administration (TPA) website. Just a bit of reading and effort can save you from all the hassles and ensure timely compensation.
TIMING MATTERS
YOU have to submit all relevant documents along with the claims’ form within 30 days from the date of discharge of the patient. As per industry estimates, 25-30 % of customers do not maintain this time schedule. On paper, insurers do not entertain any claims after 30 days. However, in reality, the insurance companies do consider such delays on a cases to-case basis. If the reason for delay is genuine, then the insurer may pay the compensation..
KNOW THIS
EVERY policy comes with some provisions, exclusions and riders. You may have opted for a deluxe room along with a television at a hospital. But that comes with a premium and it’s not necessary that your insurance claim pays for additional luxuries you opt for. So it’s important for you to know what your policy covers and what you have to pay yourself.
Broadly speaking, health insurance policies cover boarding, nursing and diagnostic expenses like room rent charged or doctors’ fee A health policy, however, doesn’t cover ailments in the first year from the effective date of the policy. It covers hospitalization charges for heart attacks, strokes, medicines, loss of limb or other parts of the body due to accident, injuries and maternity expenses. You cannot claim for expenses on hospitalization, incurred in the first 30 days.
Similarly, your health policy will not cover pre-existing diseases or health problem if you take insurance at a later stage. Pre-existing disease is the one you have at the time of taking policy and which you have not disclosed. For example, if you have an asthma problem or diabetes, then you can’t claim the expenses incurred on the treatment for these health problems under a mediclaim policy.
Last, but not the least, a mediclaim cannot come to your rescue all the time. ICICI Lombard and Oriental Insurance give insurance cover up to the age of 75 years. Bajaj Allianz, on the other hand, gives you a mediclaim policy if you are less than 50 years while the age limit for senior citizens is 75 years. New India Insurance offers policy till 80 years.
Healthcare costs are going up and at any point of time; you should be able to get the best doctors at affordable price. In fact, you start a mediclaim only to ensure that you provide for your medical expenses.
So don’t get lax and be sure of what your policy reads well in advance. That will help you during contingencies!
Complaints are largely on account of underpayment or even rejection of claim payments by health insurers. Considering that events leading to health insurance claims themselves are stressful, any issue with the insurance compensation only adds to the stress.
Industry experts say there have been some common misses by customers while making a claim. Let’s look at what you need to do to ensure a hassle-free health claim.
PAPERWORK
INSUFFICIENT documents are some of the most common causes of a dispute. Insurers ask for original bills and documents to ensure that customers do not make multiple claims. Also, you have to submit a document called discharge summary, which adds to the authenticity of your claim.
He says the simple logic is that every outgo has to be supported with an authentic document, which justifies the expenditure. For example, if you claim for consultation receipt by the doctor, then you have to submit the prescription along with the claim form.
Similarly for diagnosis, you have to submit the diagnostic report and medical reports such as X-rays and scans for an operation. Similarly, medical bills have to be numbered. Just a list of medicines on a clinic’s letter head or with a rubber stamp will not suffice. In fact, the list of documents you have to submit is mentioned on the reverse of the claim form or any of the third-party administration (TPA) website. Just a bit of reading and effort can save you from all the hassles and ensure timely compensation.
TIMING MATTERS
YOU have to submit all relevant documents along with the claims’ form within 30 days from the date of discharge of the patient. As per industry estimates, 25-30 % of customers do not maintain this time schedule. On paper, insurers do not entertain any claims after 30 days. However, in reality, the insurance companies do consider such delays on a cases to-case basis. If the reason for delay is genuine, then the insurer may pay the compensation..
KNOW THIS
EVERY policy comes with some provisions, exclusions and riders. You may have opted for a deluxe room along with a television at a hospital. But that comes with a premium and it’s not necessary that your insurance claim pays for additional luxuries you opt for. So it’s important for you to know what your policy covers and what you have to pay yourself.
Broadly speaking, health insurance policies cover boarding, nursing and diagnostic expenses like room rent charged or doctors’ fee A health policy, however, doesn’t cover ailments in the first year from the effective date of the policy. It covers hospitalization charges for heart attacks, strokes, medicines, loss of limb or other parts of the body due to accident, injuries and maternity expenses. You cannot claim for expenses on hospitalization, incurred in the first 30 days.
Similarly, your health policy will not cover pre-existing diseases or health problem if you take insurance at a later stage. Pre-existing disease is the one you have at the time of taking policy and which you have not disclosed. For example, if you have an asthma problem or diabetes, then you can’t claim the expenses incurred on the treatment for these health problems under a mediclaim policy.
Last, but not the least, a mediclaim cannot come to your rescue all the time. ICICI Lombard and Oriental Insurance give insurance cover up to the age of 75 years. Bajaj Allianz, on the other hand, gives you a mediclaim policy if you are less than 50 years while the age limit for senior citizens is 75 years. New India Insurance offers policy till 80 years.
Healthcare costs are going up and at any point of time; you should be able to get the best doctors at affordable price. In fact, you start a mediclaim only to ensure that you provide for your medical expenses.
So don’t get lax and be sure of what your policy reads well in advance. That will help you during contingencies!
