What good is a medical insurance policy if the claims process has you running from pillar to post, frustrated? Here’s how you can avoid both the hassle and the heartburn.
Enough and more has been said about the importance of taking medical cover. But what good is a policy if the claims process has you running from pillar to post, frustrated? The key is to be aware of the basic conditions laid out in the insurance contract, and sidestepping minefields both during and post hospitalisation.
Most insurance claim battles ensue because of one endemic problem: Private hospitals, in their quest to generate maximum revenue, encourage patients covered by a medical insurance policy to undergo medical procedures which may be unnecessary or irrelevant, and health insurers have been known to reject claims saying it was not medically required.
So, to keep things simple, here are some quintessential steps you can take if you need to be hospitalised.
BEFORE GETTING HOSPITALISED
Unless its an emergency visit, make sure the hospital you choose boasts a registration certificate. This is because in a few recent cases, insurers have rejected health insurance claims stating that the hospitals did not hold a valid certificate.
Adds Dr. Nayan Shah, chairman and managing director at Paramount Health Services, a third party administrator (TPA): "In urban areas, an approved hospital should have more than 15 beds, while in level-B cities, the minimum criteria is 10 beds."
Also, be aware that the list of network hospitals is revised frequently. "Choose a hospital only after checking the list on the website of the TPA or calling them up, as every year they downgrade some hospitals and remove some," suggests MD Garde, who acts as an independent consultant to insurance companies.
Recognising the pitfalls of such frequent amendments, the recently-released draft guidelines issued by the Insurance Regulatory and Development Authority to protect the interest of health insurance policyholders takes the matter head-on.
One of the proposals suggests: "Where a policyholder has been issued a pre-authorisation for the conduct of a procedure in a given hospital or if he is already undergoing treatment, and the hospital is proposed to be removed from the list of network provider, the insurer will 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 hospital’s name is removed later from the insurance company’s list.
Enough and more has been said about the importance of taking medical cover. But what good is a policy if the claims process has you running from pillar to post, frustrated? The key is to be aware of the basic conditions laid out in the insurance contract, and sidestepping minefields both during and post hospitalisation.
Most insurance claim battles ensue because of one endemic problem: Private hospitals, in their quest to generate maximum revenue, encourage patients covered by a medical insurance policy to undergo medical procedures which may be unnecessary or irrelevant, and health insurers have been known to reject claims saying it was not medically required.So, to keep things simple, here are some quintessential steps you can take if you need to be hospitalised.
BEFORE GETTING HOSPITALISED
Unless its an emergency visit, make sure the hospital you choose boasts a registration certificate. This is because in a few recent cases, insurers have rejected health insurance claims stating that the hospitals did not hold a valid certificate.
Adds Dr. Nayan Shah, chairman and managing director at Paramount Health Services, a third party administrator (TPA): "In urban areas, an approved hospital should have more than 15 beds, while in level-B cities, the minimum criteria is 10 beds."
Also, be aware that the list of network hospitals is revised frequently. "Choose a hospital only after checking the list on the website of the TPA or calling them up, as every year they downgrade some hospitals and remove some," suggests MD Garde, who acts as an independent consultant to insurance companies.
Recognising the pitfalls of such frequent amendments, the recently-released draft guidelines issued by the Insurance Regulatory and Development Authority to protect the interest of health insurance policyholders takes the matter head-on.
One of the proposals suggests: "Where a policyholder has been issued a pre-authorisation for the conduct of a procedure in a given hospital or if he is already undergoing treatment, and the hospital is proposed to be removed from the list of network provider, the insurer will 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 hospital’s name is removed later from the insurance company’s list.
No comments:
Post a Comment