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Why Health Insurance Companies do not Reimburse Claims to The Full Extent?

IndiaNotes Team | 15 Jun, 2016  | Follow Author | Add to my Favourites 
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It is said that money can buy everything but does that fit true? Money cannot buy you everything. Not your life indeed but then it makes things easier for you, your health at least. Every person needs to have a health insurance for himself.

What exactly is the role of a Health Insurance Company?

When once you go for a health insurance like any other insurance, the insurance company after that is responsible for paying all the medical costs for the person who is sick and is insured. Health insurance can be used when you are ill or if you are in the hospital because of an accident.

Before going in for a health insurance keep the following things in your mind:

  • Always evaluate your insurer before you decide on the plan offered
  • The hospital network for cashless treatment should be thoroughly checked
  • Go for free quotes from various insurance companies
  • Look for the financial ratings of the individual insurance companies
  • After you have selected a list of the health insurance companies, the next task is to go through the educational history and the employment history of all the doctors who are associated with these insurance companies
  • Look for all the reviews for all the selected insurance companies by you and then decide the one

Now that you have chosen the company and bought the insurance,the next vital task isto understand how health insurance reimbursement works?

In total, there are twoprimary methods of availing the insurance claim

1. Cashless hospitalization

This is basically plannedhospitalization which means that you need to inform the insurance company when you plan to get hospitalized. Along with that mention the policy number and quote the Health ID card. This should be done 4-5 days in advance.

This cashless hospitalization service is available at the admission counters. It is necessary for the patient to fill up all the valid information. Any invalid information in the form can lead to rejection.In case of any surgery, the medical condition is filled by the doctor

2. Non-Cashless Hospitalization

In the event of any emergency, the intimation for the claim to the insurer should be made within 24-48 hours of admission depending on the insurer. One needs to fill all the details like policy number, health card number, name, address, thename of doctor, name of thehospital, and type of injury.

After this, attach the documents like original reports, original prescription, surgeon’s certificate, all the bills, hospital receipts, discharge certificate, FIR if there is an accidental injury.

In both the above cases, after the company feels that all the documents and information are up to the mark the claim is then approved.

The truth behind the expensive hospital room rent

While going for a health insurance policy, your agent will tell you about this bitter truth.

1% or 2% of the sum assured for your policyis restricted to room rent.

If you have a policy of 5 lacs then basically, 1% of your room rent if we count by per day turns out to be Rs. 5000. So, if you go to a hospital room whose rent is more than Rs. 5000 then you end up paying from your pocket.

The expenses of the hospital will be more expensive if you choose a costly room. The same treatment can be taken with less amount in a general ward.

So, before going in for any of the policies thoroughly read each and every line of your insurance contract. They have ample hidden clauses in them.The insurance companies will not reimburse you for the consumable items like the gloves, syringes, masks, diapers, and so on. Similarly, the service charges and the registration fees, if any is not reimbursed. That is the reason why you will never get the full amount on the expenses claimed related to your health insurance.

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