Simplest Guide for Health Insurance in India

Many times there are cases that insured a person who files claim does not provide proper documents. In these cases the claims are rejected. So here is what to do after Health Insurance Claim Rejection:

• Know the reason from TPA
• Check the claim form
• Contact the TPA
• Check the documents submitted
• Gather medical proof
• File an appeal
• Approach Ombudsman

To read each in detail see Is your Claim rejected? Follow these steps!

Claim rejection happen because of the mistake made by the policy holder. So here are certain things policy holder should know in order to avoid Claim Rejection and ensure a Smooth Health Insurance Claim Settlement:

• Read the fine print very carefully at the beginning so that you are aware of what is covered and what is not.
• Take copies of all the documents that you submit along with the claim form to the TPA for future reference.
• Submit the claim request within 30 days of the hospitalization if you are including the post hospitalization expenses; send it within 90 days of hospitalization.
• Check all the details provided in the claim form for accuracy.
• Send all the necessary medical records to the TPA.
• Gather sufficient medical opinion in support of the treatment and send it to the TPA.

To know more see Is your Claim rejected? Follow these steps!

A health insurance claim is a bill for health care services that your health care provider turns in to the insurance company for payment. So here are some reasons why your claim will not be paid:

• Ailment not being covered in the health insurance policy (Exclusion)
• Improper claim form filled
• Procedure deemed medically unnecessary
• Claim not filed in time

To know more see Is your Claim rejected? Follow these steps!

You may notice that even with the cashless service, there are some expenses that you will have to bear, these expenses are:

• Registration or admission fee
• Visitors/ Attendant’s fee
• Charges for diet
• Ambulance charges
• Toiletries
• Document charges
• Service charge

To know more see Cashless Hospitalization

In an emergency hospitalization, the important thing is to get the patient treatment at the earliest. You need to start the procedure for cashless facility within 24 hours of hospitalization.

• Show your health insurance card and fill in the pre-authorization form.
• The insurance desk in the hospital will fast track the process for your cashless process but in case you cannot wait for the approval, you can pay the deposit if demanded by the hospital and start the treatment and reimburse the expense later on.
• Generally the time to taken to process an emergency case is 6 hours. You need to follow up with the TPA to know the status of the request.

To know more see Cashless Hospitalization

In a planned hospitalization, you have a recommendation for hospitalization by your doctor and have time to decide which hospital to go to. You have to complete the formalities at least 3-4 days before you are hospitalized.

• Take a look at the list of network hospitals  provided while buying the Health Insurance policy or call the toll free number on your health insurance card and select the network hospital nearest and most convenient to you.
• Show your health insurance card and fill up the first part that is to be filled by the patient of the ‘pre-authorization’ form that you get in the insurance desk of the network hospital or which you can download from website of your TPA.
• Provide the filled form on the insurance desk of your hospital, the person at the insurance desk will verify its completeness and then fax it to the TPA.
• The TPA will then process the form and either approve or reject the request.
• If your form is approved, the TPA will send the authorization letter with an approved amount for the treatment.

To know more see Cashless Hospitalization

Health insurance companies make tie-ups with hospitals after negotiating their rates and checking their quality. These hospitals are called as Network Hospitals; Cashless service is available only in these hospitals. To know which hospitals are in your health insurance provider’s network, check the name of your TPA in the policy and visit its website or call their toll free number. orange customer services home

TPA or Third Party Administrators are the representatives of the health insurance companies who are responsible for settling the claims both reimbursement claims as well as cashless claims. It is the TPAs who have to approve your request for cashless and provide the service.

Pre authorization form is the form that you get at the insurance desk in the hospital or in the website of the TPA, after being duly filled by the patient and the hospital’s representatives, it is sent to the TPA which decides to approve or reject the claim.

To know more see Cashless Hospitalization

In Cashless Service, when you get hospitalized with a network hospital, you do not have to settle the bill with the hospital. The Insurance Company represented by the TPA, co-ordinates with the hospital and settles the bill.

Some pointers about the Service

• Cashless service is only available in network hospitals.
• All the medical documents including the lab reports, claim forms, discharge summary and final bill has to be submitted to the hospital before being discharged.
• To ensure that your request is not rejected, send a completely filled pre-authorization form and send it within the required time frame.
• Cashless facility is subject to the conditions and terms in the policy.

To know more see Cashless Hospitalization

Do you think that being in late teens and early twenties is a very early age to think about health insurance? Then answer this- When you can vote, race your bike or car, break rules, stay out late and finally decide what to do with your life, then having Mediclaim at a young age becomes a need too. Here is why you should buy Health insurance:

1.       Use the advantage!

When you want to buy a health insurance policy later in life you find numerous limitations and conditions to face! You will have to undergo a waiting period for pre-existing diseases and the premium will be high. On the other hand, when you buy a policy now, you will have no pre-existing disease, hence mostly all the diseases will be covered. 3600 mah Motorola Photon 4G

2.       Your Investment for the future

You may feel that buying the policy at this age will only mean losing that premium money, but actually the cost of the premium is negligible compared to amount that you may have to pay in terms of a hospital bill. Even if you don’t claim for a period of ten years, your investment in health insurance will be a profitable one. Imagine paying Rs. 1200 for 10 years which means Rs. 12000 at the end of the 10 years. On the other hand even a simple hospitalization will come to Rs. 20,000. So in all ways, you will profit. ny maid service: Manhattan, 529, East 5th street Apt. RS, 10009.

To know more see Eligible to Vote? Time to Buy Health insurance!

You may feel that buying the policy at this age will only mean losing that premium money, but actually the cost of the premium is negligible compared to amount that you may have to pay in terms of a hospital bill. Even if you don’t claim for a period of ten years, your investment in health insurance will be a profitable one. Imagine paying Rs. 1200 for 10 years which means Rs. 12000 at the end of the 10 years. On the other hand even a simple hospitalization will come to Rs. 20,000. So in all ways, you will profit. This amount will only increase as the inflation in medical industry goes on increasing. Thus, your investment in health insurance will be an investment in the future, more profitable and guaranteed than other investments you can think of!

To know more see Eligible to Vote? Time to Buy Health insurance!