Tag Archive | "Health Insurance"

Challenges Faced Under Cashless Health Insurance Claims

  • Easypolicy
  • 04 Mar 2014

Over the past few years, the popularity of cashless health insurance has shot up several notches and for quite the reasons most apparent. The major advantage of this Policy is to ease the burden of financial losses that need to be incurred at the time of any unforeseen accident. Holding a cashless Health Insurance means that the Hospitalization and other charges are taken care by the service provider. Cashless service calls for a hassle-free process in which you do not have to bother about the cash in case of any emergency. However, there are a few challenges that people have to face while dealing with cashless health insurance claims

Some of the major reasons behind challenges faced during the utilization of cashless health insurance are: lack of sufficient knowledge, the companies not disclosing the facts properly, difference in Proposal forms, and excessive expenditure. Normally, the customers are not completely aware of the Exclusions of their cashless health insurance. This happens when they do not go through the terms and conditions while buying the insurance. The easiest way to avoid this is going through the terms and conditions provided by the insurance company. Most of the companies provide a free-look period of about 15 days in which you can either continue or cancel the contract if you feel it does not serve your purpose adequately.

Another challenge that customers have to face while claiming for cashless insurance is unavailability of hospitals in the insurer’s chain. Quite a few times, the customers are not provided with a list of the hospitals in which services are available, which makes the matters worse, during emergency cases as one would find it difficult to get to the listed hospital. Even if you managed to get everything right, the turnaround time for the insurance Claim can be a real pain in the back. There is usually a long and painful process in which the customers are left running between the hospital and insurance office. At times, simple things such as sending a mail or fax takes up two hours.

In case of planned admits, the process is somewhat simplified as the customers have the upper hand as far as time factor is concerned. Another issue that quite a few customers face during the claim of cashless insurance is a rejection of their cases in the lack of adequate information. Though the services differ from TPA to TPA, but customers are generally at the receiving end. If a few steps are followed the hassles can be avoided to a great extent. So, it is better for you to get the list of the hospitals under cashless service, read the terms and conditions properly, inform the TPA as soon as possible and always be ready with documentations.

how to prevent rejection in a health insurance claim

  • Easypolicy
  • 31 Jan 2013

Numerous factors can contribute towards rejection of Health Insurance claim. An insight into them will lead to adoption of proper means to steer clear of such hurdles.

Deficiency of knowledge

Customers are caught unawares about the Policy Exclusions as they are disinclined to pore over the health Coverage plans’ terms and conditions during purchasing. This costly mistake drives your attention away from policy Term when you specifically act in disregard to it. The agent in haste to make commissions often keeps you in dark about the limitations. 

You should thoroughly go through the policy conditions and seek clarification about cryptic clauses to avoid Claim rejection. You should utilize the free look up period offered by insurance company to cancel the policy if you discover that the policy terms deviates from the understanding instilled in you by the agent.

Facts not disclosed
A significant contributor for denial of insurance cover is non-disclosure/partial or wrong disclosure of facts pertaining to existing diseases, occupation, income, medical conditions etc. Any deviation from facts stated on the Proposal form at the time of filling often leads to declining of coverage.

The solution lies in understanding the consequences of hiding or providing incorrect information when applying for a product. Every health policy operates based on Underwriting principles that draw the information furnished by you. If you are prospecting a suitable policy, divulging all relevant information is crucial.

Proposal form disparities

Inadvertent errors creep in the proposal form owing to the dependence of customers on intermediaries for filling up the proposal form. The intermediary is unaware of accurate details and blunders happen in the declaration form. When you buy health insurance with incorrect representation of materially vital facts, the Insurer rejects your claim upon verification of the same in detail.

The solution lies in filling up the declaration form by yourself rather than relying on the expertise of agents. Only authentic documents should be submitted while purchasing the policy. Document submission should happen in an orderly manner on time. After receiving the policy papers bundled up with photocopies of the application form and relevant documents, go through them intently to check the veracity of papers filed with the insurance company. Any discrepancy should be brought to the notice of company and rectified instantly. Remember, laws also enable insurer to repudiate the claim if it proves that any vital information has been withheld by the Policyholder during renewal or purchase of policy.

Excess expenditures

Insurance company often reject claim stating that the medical procedure undergone was not mandatory. It has now become a trend, earnestly followed by private medical facilities to subject the patient to unnecessary medical procedures in pursuit of more revenues. It assumes a more severe form if the facility comes to know that the patient is paying health insurance premium. The policyholder assumes on misunderstood grounds that the entire expenses would be borne by the insurer. Certain consumers also present inflated claims through the doctors by outrageously distorting the actual expenditures incurred. The irregularities float in sight upon investigations conducted by the health plans provider.

The solution is to limit the procedures to fulfill the conditions stipulated when you buy health insurance.

how can you keep rising health insurance premiums in check

  • Easypolicy
  • 31 Jan 2013

When you or your family member falls ill, the entire family is emotionally, physically and financially in distress. In most cases, financial crisis affects the family badly and is very difficult to deal with. The cost of treatment for many illnesses today run into lakhs of rupees. Therefore, the most significant thing that you and your family need is a Health Insurance Policy that comes to your aid during a medical emergency.

But these days, the cost of health insurance too is going up and you need to look for ways to save money on your insurance. While you cannot do much to reduce the premiums, you can reduce its impact on the sum Insured by controlling your medical expenses. While it might be impossible to completely eliminate medical bills altogether, it is possible to reduce your medical bills. You can take certain steps to eliminate unnecessary expenditure on mediclaim.
Here are some factors you must take care of that will enable you to achieve this:

1.Manage Your Health

You need to take good care of your health to stay healthy. For this, you must eat healthy food on time, sleep well, drink lots of water, take adequate rest, exercise and so on. 

2.Preventive Action
Preventive action such as periodic checkups and body scans can help in detecting illnesses at an early stage. This will help in reducing the cost of treatment and health insurance.

3.Buy Insurance Early

As the Premium of health policies increase with age, you must buy a health policy as early in life as possible. With age, health issues increase and so does the health insurance premiums.

4.Purchase Family Floater Policie

Family floater health policies are always cheaper and are more advantageous than individual health plans.

5.Coverages and Exclusions

It is important to know the coverages and exclusions of your policy so that you buy the right one. You must not end up paying a large sum for a health policy that is not going to be useful for you.

6.Avoid Cigarettes and Alcohol

Cigarettes and alcohol are two of the biggest killers in the world. One of the best ways you can reduce your Mediclaim premium is by staying clear of cigarettes and alcohol.

7.Review Policies Periodically

You must review your mediclaim policy every year and upgrade it to ensure that you have the best insurance cover with the right features.

8.Choice of Policy Features

Carefully study and select policy features, which is a good way to reduce health Coverage costs. For example, depending on the claims made in the previous year, certain companies increase your premium. You must then switch to another company that charges you lesser premium.

9.Choose Doctors and Hospitals in Your Network

Choosing a doctor, medical lab, hospital etc in the network provided by your insurance provider is a good way to bring down insurance costs.

10.Purchase Online Policy

Compare and study different health plans online before you buy one. You can use policy aggregator sites, which will save your money as well as time.

Unlike life insurance policies where the premiums remain constant throughout life, the premiums of health plans keep changing based on various factors such as your age and health conditions. Hence, you must maintain and manage your health, and study policies carefully to reduce health insurance costs.