Thread by @joinditto

Here's a simple checklist to make sure YOUR health #insurance claims don't get rejected.

A thread.👇 (1/11)

1.) Be Honest Guys

The most helpful thing you can do for your health insurance is being honest when you're buying it.

A mistake in revealing your pre-existing diseases or not mentioning your medical history can lead to rejection & even termination of your policy (2/11)

2.) Check Exclusions
There’s no policy in the world that will offer to cover everything. So, the things an insurer can’t cover is spelled out clearly in the exclusions list... (3/11)

..Now, every policy is different, but key things to look out for would be - Waiting periods for pre-existing diseases, Hospital costs (co-payments, room rent limits, consumables, etc.) & permanent exclusions.

You really don’t want to skimp on this, so read it carefully. (4/11)

3.) Be Wary of Blacklisted Hospitals

Hospitals are blacklisted when they are found to be artificially inflating medical bills. Every insurer has its own internal list of blacklisted hospitals to avoid. (5/11)

Note: If it is a genuine emergency, like emergency accidents or a heart attack, IRDAI allows you to go for blacklisted hospitals, but you might need to prove it to the insurer to get your claim accepted. (6/11)

4.) Usual, Customary & Reasonable Clause

This clause basically means that to prevent abuse, an insurer has the right to reject a claim if it finds that the charges or the treatments performed were “unreasonable”. (7/11)

For instance, a normal cataract procedure shouldn't cost more than 1L, even in a very sophisticated hospital.

But if the hospital were to charge 5L and the medical records don't justify this expense, then they will reject the claim. (8/11)

The most ideal thing you can do would be to avoid blacklisted hospitals and go for insurer-approved partner hospitals.
(9/11)

5.) The Time Limit

Some insurers will tell you to file a claim within 2 days of hospitalization for an emergency cashless treatment. If it's a planned treatment, you may have to intimate them 3 days in advance... (10/11)

Needless to say, you should be aware of these time limits. All your efforts to buy a policy would be for nothing if you falter here (11/11)

And if you want honest advice on buying a health policy that would suit your needs, talk to our advisors at Ditto- bit.ly/3koiTh0