Mediclaim policy Claims
Mediclaim policy
Health policy, personal accident policy or Vehicle policy – people pay the premium regularly so that these can be useful in emergency situations. But in most of the policies, problems arise in claiming. Claims are generally rejected by the insurance companies citing the reasons such as the required documents has not been submitted or the policy is not applicable to certain disease etc. Given below are the things one should do to avoid problems in claiming policy amount from the insurance companies.
Mediclaim policies: Mediclaim is the policy which supports the policy holder when he has to be hospitalized. Insurance companies manage these policies through Third Party Administrator. In some situations Insurance companies may not allow for cashless treatment. In such situations, the policy holder will have to bear the treatment and submit the necessary documents and bills to claim the amount from the insurance company.
- In mediclaim policies, insurance coverage is not applicable to some diseases in the first year. Hernia, piles, sinusitis, stones in gall bladder are few examples. For the treatment of knee replacement surgery, prolapsed disk etc, the insurance coverage is applicable from third or fourth month. Policy holder should observe this when making a claim.
- Cashless facility is generally available in almost all hospitals. But this has to be confirmed with the TPA. TPA should be informed immediately when the doctor advices surgery. The pre-consent form and send it to TPA at least one week before the surgery.
- Injuries: When the mediclaim policy holder is injured in an accident, he should immediately take a certificate from the doctor with details like the time of the accidents etc. Otherwise problems may arise at the time of claiming.
- The documents which are submitting making a claim should not be incomplete. All the receipts have to be submitted to TPA only then there will not be any cuts in the claim.
- The cell phone number of the person who is acting as a care taker to the patient should be written in the pre-consent form. The TPA then will be able to know the details of the treatment from time to time.
- Mediclaim Policy holders should find out about the hospitals that are near to their homes and which offer cashless facility. This will be useful when there is an emergency.
Critical illness: Many health insurance policies are available in the market which cover the expenses of chronic diseases. Though these policies give coverage of few lakhs, there are also limitations. If the policy holder falls ill within 30 days of taking the policy or if the policy holder is dead, the insurance companies reject the claim.