Health Insurance: “Claims” hold the key!

“To keep the body in good health is a duty…otherwise we shall not be able to keep the mind strong and clear.” – Buddha

Not only the one above which is timeless, ‘once-in-a-generation pandemic’ Covid 19 brought along some other invaluable lessons like ‘Health Awareness’ and ‘Health Insurance.’ In case pandemic or any other disease strikes, your physical, mental, emotional and financial health is severely impacted. Though health-related issues are taken care of by doctors and family, financial health is your responsibility.

You need to buy sufficient health cover so that you don’t burn a hole in your pocket due to medical expense. Health Insurance is there to take care of your ‘financial health’ in case of a medical emergency. This way reluctance for buying health cover would cost you dear. With health cover you can avoid erosion of your wealth, you had earmarked for some other purpose.

Surprisingly, while Covid 19 has deliberated on the importance of health insurance, projecting growth of 10% annually, the coverage of the Indian population remains dismal. There are around 1135 million remain uncovered, data by NSS reveals. So, don’t be amidst them.

Nowadays, Insurance companies are offering comprehensive health plans which cover you from many a critical disease, routine diseases, medical test, pre-operative and post-operative and hospitalisation care and some highly complex surgical procedures. There would be hardly any aspect which is not covered under health insurance. You need to define your requirement and understand your policy wording properly besides some other important components like co-pay, pre-existing diseases, network hospitals, cash-less, individual, family floater, group insurance policies, add-ons, riders, no-claim bonus, tax benefits and most important claims. This way you can ensure a hassle-free claim. Once you have zero-in on a policy based on its merits, still, avail free-look period of 15 days.
In case you are still not satisfied, some policies provide 90 days period and partial return of premium too.

Premium is only one aspect, you need to know about the Claim-settlement ratio of the insurer also. It is one of the most vital factors to be considered while choosing an insurer, to know the claim settling ability of the insurer. If this ratio is low, the whole purpose of buying insurance gets defeated.

Health insurance segment is riddled with the most claim related issues owing to various reasons. Hence, many people avoid health insurance as they are unsure of what will happen when they come face-to-face with moment-of-truth (read: claim). Will brand stand to its promise or not?
Thus, for a smooth settlement of claims, you need to study and understand policy document in totality and clear all your doubts with the insurer. As a golden rule, you should not claim for insufficient medical necessity and present false or inflated bills. Transparency is key here.

There are other factors too like:
Obtain Pre-Certification or Authorization, if required.
Claim Form to be error-free w.r.t Patient Data or Diagnosis / Procedure Codes.
Honour deadline for filing claim
Denial due to insufficient medical necessity
Avoid using Out-of-Network Provider

These reasons for claim denials are key to preventing them. Nowadays insurers offer software tools to help you prevent claim rejections (claims that aren’t processed due to clerical errors) and claim denials (where claims are considered, but payment is denied). Hence, deploy these tools to get your genuine claim.

Before, filing for a claim, check if your KYC documents are in order like policy document, aadhar card or Pan card etc. which you just need upload on your mobile app for reimbursement. If this is in order, your claim will be settled in the shortest possible time.

The days of basic health plans are over, you can have as many features in your policy, you want. These would be like Air Ambulance, Dental Care, Spectacles, Unlimited room rent, Maternity coverage and Treatment abroad for any disease or procedure, besides many critical illnesses like cancer.

Hence, for availing maximum coverage and smooth claim, you need to be an aware and informed customer.

+++++++++++++++++++++++++++++++++

Deepak Choudhhary, CEO, Insurance4life.in, who writes regularly on personal finance related subjects.