NO CLAIM BY TPA

PA E MEDITEK TPA SERVICE PVT LTD

CLAIM NO 835603

NAME CHAUHAN MANOJ SHANTILAL

WE HAVE ALL READY ALL PAPERS ARE SUBMITTED BUT THE TPA WILL NOT PAY THE CLAIN LAST 6 MONTHS SO SIR PLEASE JUSTICE ME AND THANKING YOU

Non settlement of OPD bills

Dear Sir,
I had a policy of ICICI Lombard with OPD cover Health Insurance.I send my claim to my agent Akash who got it collected in Feb’10 from my residence.(all OPd bills). vide policy no 4063i/HAP/04540245/00/000 but have not received cheque for the same amount, hence refused to further extend the policy.It is surprising that such big companies do not settle the promised claims despite sending all documents in time and harrassing the said person by the Agent-Akash.
Kindly re-imburse my claim of an amount of Rs 8500/- at the earliest or otherwise I take up with higher agencies for addressal of my claim.
Regards
Seema Chandra

Not Responding My Claim(Mediclaim) Policy No 282510425333

This is regarding my claim of reliance general insurance (TPA mediassist) of my policy no 282510425333 gold mediclaim policy which was expire on 11/05/2010. I filled a claim on 11/02/2010 to claim cashless claim in aryan hospital gurgaon for my fracture left arm but mediassist denied for cashless facility and to ask pay tratment charges vide referance no(mediassist) 4729336 after that I take treatment from bajaj fracture clinic and submited all bill to reliance general (TPA mediassist) office 16-03-2010 vide referance no 4820383.
Now more than 3 months is going on but no body reply to my claim of policy no 282510425333 of reliance general insurance.
I am enclosing letter of mediassist in which they denied cashless facility and policy copy.

Regards
Surya Parkash Singh
Moblie No 9899797696
email id spspunia@yahoo.co.in

How to know if your health insurance cover is sufficient or not?

There will be times when you underestimate about the cover amount that you need and then as medical inflation continues, your cover amount may prove to be insufficient, especially for a family floater. Your Agent will sell you a product but will not necessarily give you good enough advice regarding the same.

What you can do?

Even after buying a health insurance policy, if you realise that the cover amount is insufficient, you can take a Top-up health insurance policy or Super top-up policy which adds additional cover amount at a very economical rate. Thus you get additional cover without buying another policy.

To know more see Things your Health Insurance Agent won’t tell you!

Can Health Insurance Premium amount change?

Ideally, the product you buy is the one which gives you maximum benefits at a reasonable price. But one thing that the Agent forgets to tell you when you are selecting a product is that your premium amount will change and most likely increase. The two reasons for the increase are- Age and Claims you have made.

The logic is as you grow old, you are at an increased risk to suffer from ailments and thus more likely to claim and thus at a greater risk calling for a higher premium.

 What you can do?

Before buying health insurance policy, check three things- the renewable age (the age till which you can be covered in the policy), Loading chart (with percentage calculations) and the Premium chart (the premium rates according to your present age).

To know more see Things your Health Insurance Agent won’t tell you!

How important it is to read Policy Wording?

Yes policy wording is very important. The best way of understanding if a product is good or bad would be by reading its policy wordings and here is where your agent may not be helpful. Most Agents will show you the brochure of the policy which will contain all the positives of the policy and its features. Since an average customer will not ask about the policy wordings, they miss out on knowing what exactly they are getting. It is only after you pay the premium that you get the policy wordings

Health insurance in India is hospitalization insurance that covers the hospitalization costs incurred in India but there are conditions and exceptions. There are numerous exclusions (things not covered) in the policy (OPD, dental, cosmetic, alternative (non-allopathic) treatments, etc.) and a number of waiting periods (Pre-existing -4 years, Surgeries for Cataract, Hernia- 2 years) which you need to know before you buy health insurance policy.

To know more see Things your Health Insurance Agent won’t tell you!

Should you buy health insurance from Agent or Broker?

Since your agent represents one Company and can only sell you a product of that Company, he may not tell you that there are better health insurance products available for your needs. He may be:

• Biased: He may push you to buy only his company’s products by positioning his company as better than other health insurance companies.
• Unaware about Health Care: Your agent will not generally have expertise in health care. He will not be the best person to handle your health care claims as he lacks the knowledge to discuss with the health insurance company in case of complicated claims.

Rather than buying health insurance from an Agent, Buy health insurance from a Health Insurance broker who is authorized to sell products from different companies and can compare their pros and cons. A Broker will also be in a better position to handle your claims as he has a better know-how of health care.

To know more see Things your Health Insurance Agent won’t tell you!

What are the information’s your Health Insurance Agent won’t tell you?

When you were buying health insurance policy, your agent kept repeating all your hospitalization charges would be covered. And it is now after your claim was rejected that you discovered the whole concept of exclusions! So here are some things that your health insurance agent may not tell you:

• Since your agent represents one Company and can only sell you a product of that Company, he may not tell you that there are better health insurance products available for your needs.
• Health insurance in India is hospitalization insurance that covers the hospitalization costs incurred in India but there are conditions and exceptions. This is a fact, your Agent may not mention.
• Agent forgets to tell you when you are selecting a product is that your premium amount will change and most likely increase. The two reasons for the increase are- Age and Claims you have made.

To know more see Things your Health Insurance Agent won’t tell you!

Raksha TPA/United India Insurance Company

TPA called Raksha TPA has refused a genuine claim for my mother’s surgery by giving a silly technical reason that the claim needs to be submitted to them within 7 days of discharge from the hospital (our papers reached them on 8th day as per the acknowledgment though they claim to have recd. on 10th day. Their exclusion clause was never highlighted , mentioned in the small( 2”x 3”) pocket guide in a small print. I have communicated with United India Insurance Co.but not much positive response from them so far
Dr.Abhijit Kher
9821043911
info@niramaymothercare.com

What are the condition of Top up and Super top up plan?

General conditions of the policy are as follows-

• You can take a Top up plan or a Super top up for an individual or as a family floater.
• There is a waiting period of 4 years for pre-existing ailments cover with all the companies.
• No expense will be covered till 30 days of buying health insurance policy.
• All expenses should be above the threshold limit for it to be payable.
• You can buy a top up policy even if you don’t have a health insurance policy covering the first level expenses.
• Pre and post hospitalization charges will be payable if the claim amount is above the threshold limit for Top up policies.

To know more see Top- Up your Health Insurance Policy!