MediClaim Could be Denied


Medi-claim can be denied

Health insurance, popularly known as mediclaim, has become a modern day necessity. However, in the recent past, many policyholders have seen their claims being denied by insurance companies for one reason or another. Here is a low-down on things you need to keep in mind so that when the time comes to file a claim, the insurance company does not come up with reasons to deny it.

24 hours or more: Most health insurance policies reimburse expenses on hospitalization only if the policyholder has stayed in a hospital for 24 hours. That is well-known by now.
However, some insurance companies insist on the policyholder being in the hospital for more than 24 hours, i.e. for two consecutive nights. Other than this, a room rent for two days must be charged by the hospital, for the policyholder to make a claim.

Survival period: The policy should have been active for a certain period before any claim can be made. In case of most policies, this period is 30 days, but, for some, it can be as high as 60 days. Put simply, this means if the survival period of the policy is 30 days and a patient is admitted in the hospital 15 days after taking the policy, none of the claims will be reimbursed.
This is done to ensure that individuals who are expecting to be hospitalized do not take the policy and then get the insurance companies to pay their bills. In addition, any pre-existing diseases that an individual may have are not covered at the time of commencement of the policy and in most cases are covered only after four years. Other than this, certain diseases like sinusitis, cataracts, hernia, etc, are covered only after two years.

Original bills: Most insurance companies ask for original bills to be submitted while filing for a claim. So, maintaining a record of all the original bills that are generated during the course of hospitalization is very important. If a claim has to be split
between the two insurance companies, there can be a problem.
One needs to check with the insurance companies if attested or duplicate copies of the original bills would suffice. These days, some insurance companies have also been insisting on prescriptions of a physician when accepting bills for medicines.

Filing the claim: Filing the claim as soon as possible is of utmost importance. In case of most insurance policies, the claim has to be filed within 60 days of hospitalization. Waiting beyond that can create problems with the insurer dilly-dallying on the payments.

Post-hospitalization benefits: With competition among insurance companies hotting up, insurance companies have lately started offering post-hospitalization benefits as well.
These benefits are essentially for the treatment required after the individual is out of the hospital. However, things are not as simple as they sound. One of the policies offering post-hospitalization benefits insists that such benefits will be paid only if the individual has been in hospital for five days.

Type of disease: Lately, critical illness policies have become very popular. In case of these policies, a lump sum payment is made to the policyholder if he gets diseases like cancer or suffers from a heart attack.
However, the lump sum payment will made only if you suffer from a certain type of a particular disease. All forms of cancer are not covered under the policy. So, if a policyholder suffers from a form of cancer that is covered under the policy, only then does he get a lump sum payment.

The devil, as they say, always lies in the detail. Therefore, before committing yourself to any health insurance policy, please read the fine print or Consult a Certified Financial Planner

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