The grown-up world is fascinating and challenging. One moment you are basking in the glory of achievement and another moment, you are drowned with worry about a loved one’s failing health. These trying times don’t always come with a warning. You have prepared yourself to meet the financial necessities, by insuring with a health cover. Read on to find out tips that will ease the process of hospitalization and realizing your insurance without having to run door to door. 

1) Learn about your policy and know its terms and conditions

 
The first and foremost step is to know, learn and understand your policy. What diseases/ailments it covers. What are the terms to claim the insurance? In the event of a claim, the procedure you need to follow. Remember, most ailments come without knocking on the door. For example, your insurance may cover an appendix surgery with a conditional time bound clause. To avoid a dispute and disappointment in time of need, it is necessary, you get a thorough understanding of the policy that you’ve purchased, and how to claim it’s benefit in case of need.

2) Frequently Asked Question: Why Was My Claim Rejected?

 A bitter experience leaves an in-depth mark. And you don’t want that. Especially when you are going through an emotional roller coaster on account of an untoward occurrence. There are two plausible and most common reasons for rejections.


1) Policy period. 

1. Insurance companies require its insurers to hold and complete a minimum period before they can claim and benefit from the insurance. This varies from company to company and could be anywhere between 2 years or more. You need to follow the conditions as per your insurance policy.   
2. In case of a recent upgrade to include a specific set of ailments, insurance companies do not allow remittance in an immediate effect. 

2) Claim Mismatch

I asked for gold and I came home to silver. Thankfully in real life, this kind of 

a mismatch does not happen. However, in the case of an insurance claim, many people feel cheated. This is mainly because the claims requested and actualized amount are different. You find yourself asking, why have they credited a lesser amount? The answer is simple. The claim deposited is in alignment with your policy terms. 

3) Acceptance Criteria 

When you’re faced with an adverse health condition, to assume your health insurance will cover all the costs is an illusion. Insurance policies will only cover essential costs, which are stated in the policy conditions document. 

Insuring company reserves the right to reject your claim 

1. A) If your doctor advises hospitalization to undergo necessary tests or as a measure to keep sickly people under observation. 
2. B) The insurance company will not process a claim for expensive treatments or medicines if it is not part of the policy. 

4) Honesty Is The Real Gold


The purchase between you and the insurance company is bound by an offer document. When you fill the proposal form, you are handing over an information basis, which the insurance company will record, and process all future claims. Therefore it is essential you write your vital information correctly as per your KYC details. It is equally important you maintain utmost and up to date transparency with regards to ailments and health. 

5) Reasonable & Customary Clause

Hospitals have a tendency to notch up bills, if they find that you are covered by insurance. In such cases, the Insurance Company will levy the reasonable and customary clause. What does that mean for you? Insurance companies will compare the charges of the same treatment, in hospitals located within the same area, of equivalent distinction, and basis that they will process the claim.

6) Proofing The Requirement

Insurance companies validate each and every request before processing them. To ensure the process is smooth, make sure you keep the below mentioned documents handy
.

1) All records of hospitalization


2) Doctor’s prescription. (In most cases, Insurance companies do not accept handwritten notes as a valid proof.

3) Treatment receipts 


4) All invoices

 

The insurance company reserves the right to reject your claim, if you fail to provide the required documents.