1/ I am pretty sure these eye-popping charges from Max Hospitals for Covid management appeared on your timeline too.
Let's understand:
a) how Health Insurance is likely to treat these charges?
b) how you can plan and prepare for the future?
*thread*
#covid #maxhospital
2/ Health Insurance cos won't pay based on fixed package charges, unless they are part of a pre-agreed contract.
Insurers will demand a detailed breakup of the package charges and then evaluate the claim against the insurance policy.
3/ Here's how Insurers will look at the breakup from Max
#1 Room Rent, #2 RMO Visits, #3 Nursing, are considered part of Room Chg. If these are billed separately, only Room Rent will be paid.
Consumables under # 7a & # 7b are not covered
Rest of the items are payable separately
4/
- Any ad hoc miscellaneous charge in the breakup are not payable.
- Any charge that is not reasonable (disproportionately high) will be paid only at reasonable rates.
Unfortunately, you pay what is not payable.
5/ Of course, if you have a health insurance policy with a room rent limit, you are up for proportionate deductions.
Which means that if your ICU room limit is 10K per day & you are charged say 20K per day - your entire bill may have a proportionate deduction of around 40-50%
6/ How can you prepare for long term, instead of panic?
a) Have a policy that covers each family member for 10-15L. Ideally 20L.
b) Ensure your policy has no room rent cap.
c) Get a fixed cash benefit policy for the deductions. Read about it here:
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