Case of cashless claim approved first, then rejected.

Customer gets admitted to hospital, cashless is approved for 70K

Later the patient's health detoriates and he is shifted to ICU,
the bill shot up to 3.4L.

The insurer withdraws cashless, leaving the customer shocked.

Here’s how a Beshak Expert stepped in - and turned it all around 👇 A customer was hospitalized for angioplasty, and the insurer first approvied a cashless treatment of 70K.

The hospital stay seemed routine until things took a sudden turn.

Complications arose, and the patient needed urgent ICU care.

This led to a significant increase in the total hospital bill, raising it to 3.4L.

🚨 Many buy health insurance - but DON'T KNOW their rights.

Not because they’re careless.
Because no one tells them.

IRDAI has listed 11 rights every policyholder is entitled to.
Check how many you know. Understand the exceptions👇

💾 Save this for future.
🙏 Repost to spread awareness. 1/ Right to lifelong renewability
Your insurer can’t deny renewal just because you aged or made claims or have a new disease.

⚠️ Exception:
Insurers can only refuse renewal if they can prove fraud or intentional misrepresentation.

⚠️ ⚠️ Common tactics hospitals use to inflate bills.

We cover:
1. Different tactics you should know.
2. How it impacts you
3. How it impacts your health insurance

🧵 👇 Imagine booking a buffet dinner.

But when the bill comes, the restaurant has charged you separately for prior booking of the table, using extra cutlery, calling the chef

That’s exactly what many hospitals do to inflate bills.

🚨 Why a ₹1 Crore health cover may NOT be enough once you hit 30!

In 1999, my dad was proud owner of a bumper health insurance cover!
Cover of 2 Lakhs. He found it adequate.

In 2010, I felt ₹10L was a decent enough cover.

Today, ₹1Cr still seems a bit of a stretch. But is it?

Let’s break it down. 🧵👇 1. India’s private healthcare is only getting more expensive.

The government spends just 2.1% of GDP on healthcare - one of the lowest in the world. Public hospitals are struggling, and most middle-class families don’t prefer to go there.

That leaves us with private hospitals, and we all know how expensive they are.

A thread on employer health insurance!

Every year HR sends an "insurance" email most ignore.

You shouldn't. The email usually has a deck that covers:

• The benefits you are entitled to.
• The process to enrol family members.
• The process to enrol and pay for parents’ covers and top up covers.
• The terms and conditions - which are a lot, believe me (this is ignored the most!)

~70% of health insurance customers I meet are unaware of their rights.

Know your 12 essential rights as a health insurance consumer 👇👇

💾 Save for later.
↗️ Share to spread the word.
🗨️ Let me know how many were you already aware off? 1/ Right to lifelong renewability

Your health insurance cannot be denied renewal due to age or past claims.

An insurer can deny renewal only if:
• You committed fraud or misrepresented fact
• You bought the policy with the intention to make a false claim

Patient hospitalized for 6 days
Insurer pays for 2 days - says no "active treatment" after 2nd day.

Doctor shares logic for the 6-day treatment.
Insurer still disagrees.

Should patients consult insurers before taking medical decisions?
Why do patients suffer for lack of medical regulations? First, let's understand why this happens.

So, health insurance as per the contract will pay only in case when the hospitalization is
a) "Necessary" and
b) " requires active treatment"

Health Insurance cos hiking premiums. Again!

Star Health: 10-15%
HDFC Ergo: 9-12%
New India: 10%

🧵 Thread
⦿ Why is the premium rising?
⦿ How do you deal with it?
⦿ Should you drop and invest the money instead? 1st things 1st: Health insurance premiums aren’t fixed.

Insurers can hike premiums whenever they find it necessary — not just for one person, but for an entire portfolio of customers.

And now, for some time, they can do it without regulatory approval 😬.

"What if I skip Health Insurance and build a fund to cover my family’s healthcare."

Fine print + claim hassles have forced all of us to think in this line.

Before you go down that road, here’s a thread on what you need to know
👇🏻👇🏻 Health insurance, despite its flaws, offers some powerful benefits that you should understand before taking such calls.

Let’s break down these powerful benefits of health insurance:

92% health insurance agents don't know basics.

How to find a good agent?

Thread 👇🏻

Will cover:
⦿ Why find a good insurance agent?
⦿ How to find a good insurance agent?
⦿ Where did the 92% number come from?
⦿ Questions to ask Insurance is a complicated product when buying, and more importantly when making a claim.

Not following right processes, making accurate declarations when buying, is one of the biggest reasons why claims get rejected.

🚨🚨 Important changes in Health Insurance.

IRDAI released a master circular today.

Most of the changes are applicable from immediate effect - unless there is a specific target date mentioned for the change.

Thread time 👇🏻 INCLUSIVENESS:
IRDAI has asked insurers to make available products for
1. All age groups
2. People with medical conditions, including chronic.
3. All types of treatment - including OPD!!
4. All occupations, regions, categories.

News going around: "Now people above 65 can buy health insurance."

This is MISLEADING & NOT true.

🧵 EARLIER: Health Insurance regulations had a minimum maximum-entry-age limit of 65 years.

Which meant insurers were required to design all health insurance plans to be open for people at least up to 65 years of age.

🚨 Good news: Important updates in Health Insurance.

IRDAI made some changes in health insurance, through their recently released regulations.

These come in force from 1st April 2024.

Thread 🧵👇🏻 Change in definition of Pre-existing disease.

Earlier pre-existing disease was any disease, condition that was diagnosed, treated or medical advice seeked in the last 48 months.

It has been changed to 36 months.

💡Interesting benefit launched across all health insurance plans

💎 CASHLESS EVERYWHERE

Get cashless in ALL HOSPITALS in the country.

I cover:
🤔 What is cashless everywhere
🤷🏻 How to avail this
🙄 How does it work
🤨 What should you expect
🧐 What is the catch

Here we go 👇🏻 On January 24 this year, the General Insurance Council (GIC) announced Cashless everywhere.

Who is GIC?
GIC is the apex association of all health and general insurance companies.

So basically, all insurers came together to bring cashless to all the 40K+ hospitals in India.

🚫 Insurer: "Claim rejected. Hospitalization not necessary"
🧑🏻‍⚕️ Doctor: Hospitalization is necessary

Customer: Confused, annoyed 😡🤬

This has become very very common.

Let's understand:
- Why does this happen?
- How can insurers dispute doctor's advice?
- What should you do? First, why does this conflict happen:

To make sense of this, we need to understand the incentives of both the parties involved.

Agent vs Online - whom do you buy health insurance from?

A debate more complex than Android vs iPhone

I found a reasonable answer to this question through countless interactions with customers over 15+ years of working in insurance distribution. Here's what I realized.

Online platforms are great for transactional products.
Products where the cognitive load to make decisions is low - where stakes are low, where decisions are reversible.

Simple UX and an efficient call centre do the trick.

4 myths regarding parents' health insurance through an employer you must know.

On the face of it, employer parent's health insurance looks like a no-brainer

✅ No medical tests
✅ No waiting periods
✅ Cover all diseases
✅ Faster claims

To problem kya hain? Read on 😅 𝗠𝘆𝘁𝗵 𝟭: I will remain employed for a good time. So I will always have parents cover

Not really

Note, parents' coverage with those lovely benefits causes major losses to insurers The policy is hence prone to:
a) price hikes
b) reductions in benefits

Why are health insurance top-ups so cheap?

👉🏻 What's the catch?
👉🏻 Would they remain cheap forever?
👉🏻 Should you consider buying them or just upgrading your existing cover?

Thread 👇🏻 Let's start with the basics: Health Insurance is an "indemnity" cover

Indemnity-based insurance reimburses you against "actual losses" incurred

Unlike, say a term life policy - which pays a lump sum fixed amount irrespective of the real financial loss incurred.

My parents' health insurance has become super expensive 🚀

Haven't claimed for so many years.
Should I continue or drop?

Here's how to evaluate 🧵 Thanks to crazy hikes in premiums - of around 30-60%, many face this frustrating dilemma during renewals.

Is it really worth paying so much?

Real-life claim

The customer suffered deductions of 48K on a 1 L claim in an employer policy

1.07 L Bill 👉🏻 45K deduction 👉🏻 56K claim received

Reason:
1. Room Rent limit of Rs. 1800 for a hospital in Thane (4Km away from Mumbai limits)
2. 20% Copay

#CompanyCoverNotEnough That's precisely the reason why @BeshakIN we recommend people should never solely depend on employer insurance.

a. You are not in control of the terms.
b. It's linked to your employment.
c. It can become super difficult to get a comprehensive cover once you have an illness.

💡 Quick tip: Never depend on insurers to remind you about renewals

👉🏻 You can lose valuable coverage if you miss a renewal.

🚨 Super important as you grow older, especially for Sr. citizens

Read more 🧵 But aren't insurers held responsible when they miss sending reminders?

As per an IRDAI circular, in the case of health insurance, insurers are liable to remind you before renewal.

No such requirement in Term Insurance or other products.