Cashless approval and approval for final bill to be given within 2 hours for cashless hospitalization cases for Covid-19 Patients.
We welcome the instructions of IRDA to Claims Team of Health Insurers as well as TPA's to work on 24 hours basis so that:
1. Approval for Cashless hospitalization is given to Insured or Hospital within 2 hours
2. Approval for final bill required for discharge of patients is given within 2 hours of receipt of request from Hospital
This sends a good signal to health insurance policy holders. This will also result in start of treatment and release of beds for new patients.
At present health Insurance claims are running at 2 % of total cases which means only 2 patients are Health Insurance Policy holders who are applying for claims. 98 are mostly dependent on Government Hospitals or a very small number being treated in Private Hospitals are paying out of own pocket.
Showing posts with label health insurance claims. Show all posts
Showing posts with label health insurance claims. Show all posts
Tuesday, April 21, 2020
Friday, May 25, 2012
Illegible handwriting has bothered us while lodging health insurance claims.
It is surprising to know that. Doctors’ illegible writing causes 7,000 deaths in the US every year. Individuals lodging health insurance claims have been facing lot of difficulty in reading prescription/diseases/diagnosis while filing or lodging up claim forms.
Now the change is coming – as a movement has now begun to ask doctors to write prescriptions in “separate, capital letters”. Brainchild of NGO Forum for Enhancement of Quality in Healthcare and the Quality Council of India (a semi-government organization accrediting services), its first meeting in Mumbai last week was attended by medical associations and NGOs.
This move will be welcomed by all those who were finding difficulty in reading prescription/diseases/diagnosis.
Now the change is coming – as a movement has now begun to ask doctors to write prescriptions in “separate, capital letters”. Brainchild of NGO Forum for Enhancement of Quality in Healthcare and the Quality Council of India (a semi-government organization accrediting services), its first meeting in Mumbai last week was attended by medical associations and NGOs.
This move will be welcomed by all those who were finding difficulty in reading prescription/diseases/diagnosis.
Friday, March 9, 2012
Take up your claim with Insurance Ombudsman- There are good chances of Success
Take up your claim with Insurance Ombudsman- There are good chances of Success
RIA Insurance Brokers Pvt. Ltd. has always stood by its customers and helped them to get settlement of health insurance claims from insurance companies and their TPAs.
In a recent case one of our client’s claim was rejected by the Insurer on the ground that the insured was not required to be hospitalized for abdomen pain. Furthermore, they contested that the insured should not have ever gone to hospital for such pain. The claim amount for hospitalization was Rs 18,732/-.
We believe that treating doctor’s decision is important (also proved in this case). An insured person should not take any symptom related to his health lightly, however minor it may seem. In this case too, the insured followed the advice of the doctor and was hospitalized. In a recent case we have seen that a young man collapsed during the Gurgaon Marathon due to dehydration. Unfortunately, the young man died in a leading hospital in Delhi after being hospitalized for over 30 days due to complications caused as a result of dehydration.
We advised our client to take the next step as per the process i.e to approach the Insurance Ombudsman. We helped the client in presenting his case before the Ombudsman. The Insurance Ombudsman directed the Insurance Company to pay the claim amount along with interest @ 8% from the date of the claim. The Insurance Company has paid Rs. 18,958 along with the interest @ 8% i.e. Rs. 2,401 to our customer as directed by the Ombudsman.
The settlement of Rs. 18,958 has again highlighted the fact that persistence is the key. We have always maintained that if you are persistent and have professional guidance then the chances of your insurance claim being settled in your favour are more than 98%.
RIA Insurance Brokers Pvt. Ltd. has always stood by its customers and helped them to get settlement of health insurance claims from insurance companies and their TPAs.
In a recent case one of our client’s claim was rejected by the Insurer on the ground that the insured was not required to be hospitalized for abdomen pain. Furthermore, they contested that the insured should not have ever gone to hospital for such pain. The claim amount for hospitalization was Rs 18,732/-.
We believe that treating doctor’s decision is important (also proved in this case). An insured person should not take any symptom related to his health lightly, however minor it may seem. In this case too, the insured followed the advice of the doctor and was hospitalized. In a recent case we have seen that a young man collapsed during the Gurgaon Marathon due to dehydration. Unfortunately, the young man died in a leading hospital in Delhi after being hospitalized for over 30 days due to complications caused as a result of dehydration.
We advised our client to take the next step as per the process i.e to approach the Insurance Ombudsman. We helped the client in presenting his case before the Ombudsman. The Insurance Ombudsman directed the Insurance Company to pay the claim amount along with interest @ 8% from the date of the claim. The Insurance Company has paid Rs. 18,958 along with the interest @ 8% i.e. Rs. 2,401 to our customer as directed by the Ombudsman.
The settlement of Rs. 18,958 has again highlighted the fact that persistence is the key. We have always maintained that if you are persistent and have professional guidance then the chances of your insurance claim being settled in your favour are more than 98%.
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