What is a medical insurance policy if the claim process you run from pillar to post, frustrated? Here's how you can avoid both the hassle and heartburn.
Enough and more has been said about the importance of taking medical coverage. But what good policy if the claim process has you running from pillar to post, frustrated? The key is to be aware of the basic conditions set out in the insurance contract, and minefields bypassing both during and after hospitalization.
Most battles result in insurance claims due to an endemic problem: private hospitals in their quest to generate maximum revenue, encourage patients covered by medical insurance to undergo medical procedures that may be unnecessary or irrelevant, and health insurers have been known to reject the claims saying he was not medically necessary.
So to keep things simple, here are some steps you can take quintessence if you need to be hospitalized.
BEFORE HOSPITAL
Unless an emergency visit, make sure you choose the hospital receives a certificate of registration. This is because in some recent cases, insurers have rejected claims of health insurance stating that hospitals do not hold a valid certificate., Adds Dr. Nayan Shah, President and CEO of Paramount Health Services, a third party administrator (TPA): "In urban areas, an approved hospital must have over 15 beds, while in the cities of level B, minimum criteria is 10 beds. "
Also, be aware that the list of network hospitals is often revised. "Choose a hospital only after checking the list on the website or call the TPA, as every year, they downgrading of some hospitals and remove them," suggests Guard ®, which acts as an independent consultant for companies insurance.
Recognizing the pitfalls of these frequent changes, the draft recently released guidelines issued by the Insurance Regulatory and Development Authority to protect the interests of policyholders health takes the issue head on.
One proposal suggests: "If the insured has been issued an authorization for the conduct of proceedings in a particular hospital, or is already being processed, and the hospital is proposed to delete from the list of network provider, the insurer to provide the benefits of cashless facility for the policyholder. "So, you will be covered by the insurer if you have taken prior approval, even if the name of the hospital is delisted before the insurance company.HOSPITAL
Some hospitals require health insurers to confirm whether the request of a patient is or is not admissible. A new approval must be sought if there is no change in treatment. "Think of an insured person with a broken leg after an accident which gets its application approved by the TPA. Later, if the patient also has headaches and hospital recommends a CT scan, a further approval is necessary for the same, "says Shah.
You might think that since you are insured, you do not need to keep an eagle eye on expenses that accumulate during hospitalization. There must be a mistake. Segar said Sampath Kumar, Deputy Director General, Insurance Company New India: "Just because the patient has insurance coverage, it should not ignore the considerations that would otherwise have done, try to minimize the cost and act as he would. have had he not been assured, so he has the most coverage available for the balance period. "
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Enough and more has been said about the importance of taking medical coverage. But what good policy if the claim process has you running from pillar to post, frustrated? The key is to be aware of the basic conditions set out in the insurance contract, and minefields bypassing both during and after hospitalization.
Most battles result in insurance claims due to an endemic problem: private hospitals in their quest to generate maximum revenue, encourage patients covered by medical insurance to undergo medical procedures that may be unnecessary or irrelevant, and health insurers have been known to reject the claims saying he was not medically necessary.
So to keep things simple, here are some steps you can take quintessence if you need to be hospitalized.
BEFORE HOSPITAL
Unless an emergency visit, make sure you choose the hospital receives a certificate of registration. This is because in some recent cases, insurers have rejected claims of health insurance stating that hospitals do not hold a valid certificate., Adds Dr. Nayan Shah, President and CEO of Paramount Health Services, a third party administrator (TPA): "In urban areas, an approved hospital must have over 15 beds, while in the cities of level B, minimum criteria is 10 beds. "
Also, be aware that the list of network hospitals is often revised. "Choose a hospital only after checking the list on the website or call the TPA, as every year, they downgrading of some hospitals and remove them," suggests Guard ®, which acts as an independent consultant for companies insurance.
Recognizing the pitfalls of these frequent changes, the draft recently released guidelines issued by the Insurance Regulatory and Development Authority to protect the interests of policyholders health takes the issue head on.
One proposal suggests: "If the insured has been issued an authorization for the conduct of proceedings in a particular hospital, or is already being processed, and the hospital is proposed to delete from the list of network provider, the insurer to provide the benefits of cashless facility for the policyholder. "So, you will be covered by the insurer if you have taken prior approval, even if the name of the hospital is delisted before the insurance company.HOSPITAL
Some hospitals require health insurers to confirm whether the request of a patient is or is not admissible. A new approval must be sought if there is no change in treatment. "Think of an insured person with a broken leg after an accident which gets its application approved by the TPA. Later, if the patient also has headaches and hospital recommends a CT scan, a further approval is necessary for the same, "says Shah.
You might think that since you are insured, you do not need to keep an eagle eye on expenses that accumulate during hospitalization. There must be a mistake. Segar said Sampath Kumar, Deputy Director General, Insurance Company New India: "Just because the patient has insurance coverage, it should not ignore the considerations that would otherwise have done, try to minimize the cost and act as he would. have had he not been assured, so he has the most coverage available for the balance period. "
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