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Eight Thumb Rules to claim your Medicalims

A large number of mediclaim policyholders have to claim reimbursement from their insurance companies for hospitalisation expenses, as a large number of hospitals have been removed from the list of network hospitals by the public sector insurance companies.

 

Most government-owned insurance companies (and some private insurance companies) require you to deal with a third party administrator (TPA) to make your claim, adding one more layer in the claim process. At the best of times, it takes at least 2-4 weeks for the claim to be settled.

 

Here is the list of eight thumb rules to claim your amount properly:

 

Inform the company about the impending claim via email

1. Inform the company about the impending claim via email to the TPA (or the insurance company) as soon as you are hospitalised. The said email format is available on the policy documents as well as the booklet that comes along with the card that you get for each policyholder.

 

The email sent by you must contain the full details of the policy number, date of insurance policy, date from which the policy was first taken from the insurance company, name of the policyholder, brief details of the reason for hospitalisation as well as the details of the concerned hospital.

 

If hospitalisation is due to an accident

2. Make sure that you take a print out of the same email and forward it by hand or courier and get the stamped acknowledgement on the physical copy as well. If you are using your agent to do this, don’t just depend on him to verbally inform the TPA. Make sure you get the acknowledged copy of the claim intimation email.

 

3. If hospitalisation is due to an accident, then you will need the certified copy of the first information report (FIR) filed with the police. If the accident was at home, which does not involve the police (say you slipped and fell in the bathroom at home), get your treating doctor to certify in another letter that the injuries are consistent with your claim that they were incurred in a domestic accident.

 

Get all original bills and reports

4. Get all original bills and reports and discharge certificates and submit them along with the claim (you need to make copies for yourself). Most TPAs nowadays demand copies of the indoor case papers of the hospital. The hospital will supply you with a certified copy of the indoor case papers on payment of a small fee.

 

Also, get copies of any X-ray or MRI films (again available on payment of a small fee to the hospital), since some TPAs have started demanding the X-ray/MRI films as well.

 

 

Make sure that any bills for diagnostic tests or medicines are supported by a prescription

5. Make sure that any bills for diagnostic tests or medicines are supported by a prescription contained in the indoor cases papers or a separate prescription from the treating doctor. Number all the documents/pages in the claim file. If possible cross reference all expenses and reports with the relevant prescription and bills. Keep copies of all documents submitted to the TPA and get acknowledgement from them in writing for any documents submitted.

 

6. Make sure that the claim is submitted within 1-2 days of discharge from the hospital to avoid the chances of the claim being denied on grounds of delayed submission. If you have post discharge claim amounts (such as medicines prescribed on discharge to be taken for a few weeks or months after the hospitalisation) you can submit a supplementary claim later.

 

 

Keep track of your claim status on the website

7. Keep track of your claim status on the website. Most TPAs have online claim status on their websites though, for obvious reasons, they do not publicise it too much.

 

The TPAs have a disconcerting habit of posting fresh requirements regarding your claim on their website without ever actually sending the letter to you. You will need your policy number to be able to find out the status of your claim.

 

 

Every second follow up should only be by email or by acknowledged letter

8. Every second follow up should only be by email or by acknowledged letter. This helps build up your case in case any future action is required.

 

If you follow all these steps, hopefully, you will get your claim amount relatively quicker and will not need to use the grievance redressal forums provided by Irda as well as consumer legislation and the regular courts.

 

This message contains information that may be privileged or confidential and is the property of the Capgemini Group. It is intended only for the person to whom it is addressed. If you are not the intended recipient, you are not authorized to read, print, retain, copy, disseminate, distribute, or use this message or any part thereof. If you receive this message in error, please notify the sender immediately and delete all copies of this message.

Pregnancy: Rent A Womb is SAFE

Surrogate pregnancy, an assisted reproductive technique (ART) in which a woman carries in her womb the baby of another woman, has seen a spurt in India. Due to the healthier lifestyles of to-be mothers and lower costs compared to the West, the country could become a global hub in the field, gynaecology experts say.

'The reason why surrogate pregnancy is rising is mainly because of the low-cost factor, and the preferably healthy lifestyle of Indian women, much needed during pregnancy,' Shivani Sachdev Gour, fertility expert and gynaecologist, told IANS.

'Women here are less exposed to a lifestyle with drugs, alcohol and smoking, which has a positive impact on the health of the baby as well as the mother. Also surrogacy laws in India are much lenient as compared to other countries,' added Gour.

She says she gets around 25 patients every month from countries like Britain, the US, and countries in the Middle East at the Surrogacy Centre of India Healthcare, a private hospital she runs in south Delhi.

While the cost of treatment and expenses involved in surrogate pregnancy vary between Rs.50,000 and Rs.100,000 ($1,000 and $2,000) in India, the cost in other countries like the US and Britain is nearly five times that in India, said Gour.

'Surrogacy is advised in cases of malformed uterus, or when pregnancy is life-threatening. But the reasons are slowly expanding in our country,' said Alka Kriplani, professor at the department of obstetrics and gynaecology at the All India Institute of Medical Sciences (AIIMS).

According to experts, the success rate of surrogate pregnancy at centres in India is higher than in other countries.

'In over 60 percent of cases, the prospective mother carries back a healthy baby, while the miscarriage rate is less than 15 percent,' said Gour.

Experts also emphasise on the need for stringent surrogacy norms at ART centres.

'A proper screening process is required. Apart from the carrier's age, which should be between 21 and 35 years, their medical, personal and family history should also be gauged to decipher her mental and physical well-being,' explained Gour.

After the preliminary screening of the surrogate, a well detailed contract as per Indian Council of Medical Research (ICMR) guidelines is made between the surrogate and the couples in question. The process involves all the three main parties - the parent, child and the surrogate.

Prospective parents - mostly coming to India from the US, Britain and Israel - have discovered that the surrogacy laws of other countries often come in the way of parents returning home with their children, experts said.

'Surrogacy is rising and it is important to keep an eye on the use of the technique. It can be misused also as poor women are lured into becoming surrogate mothers because of the money involved,' said Kriplani.

The draft Assisted Reproductive Technologies (ART) Regulation Bill, 2010, that lays down guidelines for the practice of surrogacy, states that the birth certificate of a baby born out of rent-a-womb arrangement should be in the names of the intended parents, who would automatically become the new born's legal parents.