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Get compensation from health insurance policy


Hospital expenses have risen sky high now and it is a big financial burden to get admitted in hospital either for illness or from an accident. This makes a health insurance policy mandatory. While it is important to have one, it is equally important to take certain care while filling the insurance application and while claiming.

We take a health policy so that it aids us during need but if the claim is denied, the agony cannot be described in words. It should be remembered that insurance companies generally reject claims with valid reasons and the important reasons are not properly filling the application while taking the policy or not furnishing proper details during claim.

Proposal document…
Almost all don’t read the proposal completely or understand it. They tend to give wrong information to some of the columns either intentionally or ignorantly. This is the reason for delayed claim in many cases. Latha is suffering from diabetes for the last 2 years but she did not disclose this to the insurance proposal fairing denial of application. Five years passed by and Latha suffered severe illness secondary to diabetes. She was hospitalized and a claim was made but the insurance company denied the claim saying the she had concealed her diabetes in proposal.

In order to avoid such situations, first read the proposal carefully and be truthful with your health status. This makes claims hassle free and always disclose any diseases you may have in proposal.

Disclose all your eating habits and lifestyle. Don’t take habits like smoking or drinking. this may result in hike in premium but if you hide the truth, it may result in future agony.

In case the insurance agent fills out the application, sign on them only after confirming that everything is correct. Always try to fill it on your own. In case of Latha, she couldn’t realize the mistake made by the agent and now lamenting the denial.

No fake bills…
Some try to get higher compensation submitting fake bills. This may result in claim denial or sometimes cancelation of policy altogether. Raju got admitted in the hospital due to food poisoning. He recovered after 2 days of treatment. As there was no facility for cashless treatment, he paid the bills and applied the insurance company for compensation. He submitted bills tuning to 50 thousand and claimed for compensation. However, the insurance company after investigating the claim found that the treatment cost didn’t exceed 20 thousand and while denying the claim also canceled the policy for attempting fraud. A small mistake denied a health policy to him and his family. A survey says that most feel that bloating hospital expenses is not a crime and this very alarming. Claiming for hospitalization when it was not done and changing dates of previous hospital bills are some of them.

You have to understand some things about your health policy, be it individual or the one provided by the company.

Sub limitations: Some policies have limitations in terms of compensation. Room rent, special treatments are paid only a maximum predefined percentage of the total policy. So, always learn about these before taking a policy. Service charge, registration fee while admitting in the hospital, and other fees not related to treatment are not paid. However, adding some special add-ons can have these paid for also.

Copay: Some policies need copayment by the policy holder of the total expenses in a hospitalization. these have some less premium and keeps changing from company to company and policies. Always estimate the burden you may have to face in case of hospitalization before taking a policy.

Waiting period: Some diseases are covered only after some time has lapsed in the policy period. Know about this beforehand and as this keeps changing with policy, always ask for any such things.

Daycare treatment: Health insurance is generally paid if at least 24 hours are spent in the hospital. But some treatments do not need stay for 24 hours, like cataracts, chemotherapy/radiotherapy, etc, which are done within hours. so, check whether your policy covers this or not.

Are your documents correct?
It is estimated that the main reason for delay in cashless treatment is not having full details in 30% of the cases. There may be delay even in reimbursement if full bills are not submitted. Claim form, discharge card, original hospital bills, list of total expenses, prescription slips, medical test reports are to be submitted. All have to originals and duplicates are not accepted.

While choosing a policy….
While taking a policy, while learning about the total amount and the premium, another important factor should the claim settlement history. It is also important to know whether the company is doing the transaction of claims on its own or having it done by a middle man. Company directly involved in claims does the settlement faster.

The happiness is beyond words if the policy we took helps us when in need. So don’t forget that submitting full details and staying truthful is the only way to go here.