Home > Money > Question
Need Expert Advice?Our Gurus Can Help
Sanjib

Sanjib Jha  | Answer  |Ask -

Insurance Expert - Answered on Dec 22, 2022

Sanjib Jha is the CEO of Coverfox Insurance. His expertise includes health and auto insurance. He has over 22 years of experience in the financial sector. He has completed his post-graduation from the Institute of Company Secretaries of India.... more
Anand Question by Anand on Dec 22, 2022Hindi
Listen
Money

Dear Sir, recently I was admitted to Manipal hospital. As I am suffering from ESRD my transplanted kidney also not working properly after 7yrs. I planned for to go for peritoneal dialysis. So it involves PD catheter insertion in abdomen through surgery. I was in hospital for 3 days. As I was having Bajaj Allianz health guard policy I claimed for cashless claim on 16 the Nov ‘22 got discharged on 19the Nov. As there is no proper response from the company I paid by cash 210000/- got discharged and till today 24the Nov they haven't given final approval. Kindly request you to suggest me in this matter.

Ans: Hi Anand, very sorry to hear about your plight. Seeing that you are not getting any response from the insurer, my advice would be that you approach ombudsmen and register your complaint. You need to email them at complaints@irdai.gov.in with your query along with all the documents of your case.

DISCLAIMER: The content of this post by the expert is the personal view of the rediffGURU. Users are advised to pursue the information provided by the rediffGURU only as a source of information to be as a point of reference and to rely on their own judgement when making a decision.
Money

You may like to see similar questions and answers below

Sanjib

Sanjib Jha  | Answer  |Ask -

Insurance Expert - Answered on Jun 21, 2022

Listen
Money
Dear Sir, Greetings of the day. I have got a health insurance of family floater type from Tata AIG for a sum of four lakhs. Recently, I got hospitalised and full four lakhs was paid by Tata Aig. But my hospital bill was six lakhs and sixty two thousand. So there was a shortfall of two lakhs sixty-two thousands. I have an Aditya Birla health Policy of family floater type for 45 lakhs. But it will come in to effect after 5 lakhs expenditure. So I myself paid one lakh from my pocket. And for rest one lakh sixty two thousand only I applied for cashless to Aditya Birla .But they denied it. Finally I paid that amount myself and came home. Afterwards I kept continuous follow up with them. Reconsideration and reminder letter was sent by TPA and Treating doctor. But again it was rejected. Now Aditya Birla employee is saying apply for reimbursement. When Tata Aig is clearing full amount, how come Aditya Birla is denying it? And how can I bridge the gap one lakh between two policies? Tata Aig says you have taken full claim so we cannot make your limit from four to five lakhs this year. Pls advise suitably. Best Wishes
Ans: Hi Mr. Tripathi, greetings to you. To answer your first question as to why Aditya Birla won’t provide you with cashless claim as opposed to TATA AIG is because the policy you bought from Aditya Birla is a ‘Super top up plan’ which basically means it is an addition to your base policy which in your case is your TATA AIG policy.

Super top up policies do not offer cashless claims but only provide reimbursements.

The one lakh gap, unfortunately, cannot be filled at this point. However, while renewing your policy you can opt for increased sum insured with TATA AIG. The insurer will ask you a set of questions and schedule medicals to analyse your risk profile. Post that based on your reports, the insurer will take a decision on increasing the limit.   

..Read more

Sanjib

Sanjib Jha  | Answer  |Ask -

Insurance Expert - Answered on Nov 24, 2022

Listen
Money
I was customer of Oriental Bank of Commerce. Being a customer of Oriental Bank of Commerce, Oriental Insurance Company provided Group Health Insurance Policy and inception date was 04-05-2015. My policy with them continued till 03-05-2021 without any break. Because Oriental Bank of Commerce merged with Punjab National Bank, Oriental Insurance Company discontinued that policy from 03-05-2021 onward. Being a customer of Punjab National Bank, I approached them, and they migrated my Group Health Insurance Policy of Oriental Insurance Company to Star Group Health Insurance Policy for customers of Punjab National Bank from 04-05-2021 to 03-05-2022.  As All my policy periods were continued from 04-05-2015 till 03-05-2021 with Oriental Insurance Company, Star Health Insurance given me the benefit of pre-existing disease waiting periods being waived because of continuity (They mentioned it in Policy Document too). They reimbursed my 1st claim of 15 July to 22 July 2021 (Non Empaneled Hospital) and Cashless claim of 16 December to 19/12/2021 but denied reimbursement of 19/12/2021 to 26/12/2021 with the excuse of pre-existing disease even I directly shifted from cashless hospital to non-Empaneled Hospital for same problem because Empaneled hospital having been less facilities.  Here I want to address that I was discharged from Cashless Hospital, on request, to get treated in Higher Hospital and treatment was in continuation of previous cashless hospital to new hospital. So, sir, please guide me accordingly as my correspondence with them is not fruitful.

..Read more

Ramalingam

Ramalingam Kalirajan  |6977 Answers  |Ask -

Mutual Funds, Financial Planning Expert - Answered on Apr 05, 2024

Listen
Money
My father is 89 years old and has recurring abdominal pain from last few months. In Apr'23 he was admitted in one private hospital at our locality and admitted for 7 days due to the pain issue. Various tests were conducted including blood tests, CT scan, fibroscopy and endoscopy, no major issues observed except some liver irregularities and discharged after providing certain oral medication. The cashless benefits are obtained through corporate TPA (EWA). However after certain weeks intermittently severe pain recur for almost a week and this time, on first week of July, my father was taken to Kolkata at a hospital specific to liver and digestive treatment. As advised by doctor he was admitted and again various tests are conducted including blood and stool culture, LFT, CT scan and colonoscopy..But this time also no major issues observed and he was discharged after certain medications, which differs from earlier hospital medicines. But this time claim is denied by TPA (EWA) stating that the admission is done only for investigation and observations and no line of treatment was done.. although new medicines are prescribed in the discharge summary and along with that IV fluid and some other medicines were regularly given during his stay in hospital. As TPA has denied the claim, I have to pay the entire amount in spite of paying a hefty amount of premium for my father. Can you pls suggest, why the claim is denied and whether there is any possibility of reimbursement of the claim by any means?
Ans: I'm sorry to hear about your father's health issues and the challenges you're facing with the insurance claim. The denial of the claim by the TPA (Third Party Administrator) could be due to several reasons, including discrepancies in documentation, interpretation of policy terms, or classification of the treatment as investigational rather than therapeutic.

To address this issue and explore the possibility of reimbursement, here are some steps you can take:

Review Policy Documents: Carefully review the terms and conditions of your father's health insurance policy to understand the coverage and exclusions. Pay attention to the criteria for claim eligibility and the definition of covered treatments.

Seek Clarification: Contact the TPA or the insurance provider to seek clarification on why the claim was denied. Request detailed information on the specific reasons for denial and ask for clarification on any policy terms that are unclear.

Gather Documentation: Gather all relevant medical records, including discharge summaries, prescription details, invoices, and receipts for medications and treatments provided during the hospital stay. Ensure that the documentation clearly demonstrates the medical necessity and therapeutic nature of the treatment received.

Appeal the Decision: If you believe that the denial was incorrect or unjustified, consider filing an appeal with the insurance company. Provide supporting documentation and any additional information that may strengthen your case for claim reimbursement. Follow the appeal process outlined by the insurance provider and submit the appeal within the specified timeframe.

Consult an Expert: If necessary, consider seeking assistance from a healthcare advocate or insurance specialist who can help navigate the appeals process and advocate on your behalf. They may offer valuable insights and assistance in presenting your case effectively.

Explore Legal Options: If all attempts to resolve the issue through the appeals process are unsuccessful, you may consider seeking legal advice to explore further options, such as mediation or legal action, to resolve the dispute.

It's important to remain persistent and proactive in pursuing reimbursement for legitimate medical expenses. Keep thorough records of all communications and documentation related to the claim, and continue to advocate for your father's rights as a policyholder.

..Read more

Latest Questions
Ravi

Ravi Mittal  |397 Answers  |Ask -

Dating, Relationships Expert - Answered on Nov 06, 2024

Asked by Anonymous - Sep 03, 2024Hindi
Listen
Relationship
Me and my bf are resident docters in a hospital .We hardly had time with each other ,but always supported each other in difficult times.Through fights ,breakups ,patch ups ,we were there all in these 3 years .He has always been more career oriented , hardly expressed any feelings on his own for me ,he only expressed or said i love when i asked him too .Now i m in my last year of md exams ,he got selected in aiims delhi dm since he was senior to me .Now he hardly communicates with me ,like in 48 h ,all we do is talk for 2 min ,where he hardly says anything ,sometimes he talks is about work.I have asked him multiple times if anything wrong i did ,he has kept on saying he is busy ,he says atleast i call u ,i hardly have time for anyone.He says all he sees now is his work ,patients and career . I have always adjusted according to him ,now it is becoming difficult to adjust .I cant take the trauma of leaving him ,because i have very important exams in 4 months .He was my only bestfriend ,my guide ,my love .He has been changed person .But i m studying and working almost 20 hrs , how to cope up ,i m all alone in this melodrama ,sometimes i wish i was dead
Ans: Dear Anonymous,
Your feelings are valid. It is indeed difficult to adjust to an unexpressive partner. One out of two things can be happening here- one, he does not know how to express his emotions; that is who he is fundamentally. Two, the work pressure and hectic hours have made him detached. You can try having an open conversation with him about it and let him know that you are not being able to carry on like this. Communicate your concerns and how his attitude toward you has affected your mental health. That is the only way to move forward. After the conversation either of two things will happen- it will be a wake-up call for him and things will change for the better. Or, he will continue to behave the same way and you have to rethink the relationship. My suggestion is to have the talk after your exams. I know you think he is your everything, but you are your everything. Do not let this relationship waste the years of hard work you have put into your studies. Focus on yourself and trust me when I say this- value yourself the way you want others to value you. If you don't, why would anyone else?

I hope this helps. Best Wishes.

...Read more

Anu

Anu Krishna  |1274 Answers  |Ask -

Relationships Expert, Mind Coach - Answered on Nov 06, 2024

Asked by Anonymous - Oct 31, 2024
Relationship
I am married for last 3 years. I found out about my wife's sexual past just months into our marriage. I even enquired her about her past before our marriage and told her that I don't tolerate lies and don't believe in premarital sex but she still lied to me and deceived into a fraud marriage. So I started sleeping with prostitutes and call girls as a revenge. I even had an affair with a divorced woman but that didn't last long. I know I didn't do anything wrong. She is the one is in the wrong. She deceived me into a fraud marriage. Should I forgive her and live with her?
Ans: Dear Anonymous,
instead of dealing with the problem at hand, you decided to go and create more problems?
What prevented you from actually talking to your wife. If you felt cheated, was it not possible for you to channel the anger by having a conversation with her about it? Revenge never helped anyone, but well...
Now, by blaming her, what can happen is that she will defend and you will again accuse and this will go on...
So, yes you are feeling cheated and deceived by her. You have two ways of approaching it. rebuild your marriage and start with a clean slate which means she cannot keep secrets with you anymore OR you can build more anger which is bound to destroy the marriage. I would suggest the first option where you get a fair chance to express how you feel to her and also come clean with your revenge scene with her...this may help both of you put things aside and rebuild the connection. Give this a fair shot!

All the best!
Anu Krishna
Mind Coach|NLP Trainer|Author
Drop in: www.unfear.io
Reach me: Facebook: anukrish07/ AND LinkedIn: anukrishna-joyofserving/

...Read more

Anu

Anu Krishna  |1274 Answers  |Ask -

Relationships Expert, Mind Coach - Answered on Nov 06, 2024

Asked by Anonymous - Nov 05, 2024Hindi
Relationship
Hello, I am a 42 year old woman with a 14 year old boy and a 12 year old girl. Ours was an arranged marriage. I got married at age 23 and my husband is just 2 years older to me. Right from the beginning my husband is great at cooking, household chores etc but never expresses romance openly. I was always a emotional woman who slowly turned to him and stopped expressing my needs well. So far out marriage was great cos I avoided confrontations and arguments. Only thing was he was always a critical person and I am emotional girl . Since I cld not express myself clearly as he never heard me, my communication with him sounded nagging, comparing and complaining. In 2011, he cheated on me and I learnt on his affair. I did not know how to process this phase so immediately forgave him within 2-3 days and even ended up being pregnant with my daughter. However he never used to speak on his past affair not were my feelings resolved. Whenever he would speak rudely or yelled at kids or me for little things, the past trauma would trigger and I would openly remind him of his grave mistake. This went on and he would get agitated and keep quiet. One day he did tell me that lifelong he needs to live with this past of me reminding him. But he has never understood the trauma I have gone through. I have just repressed it all along. Cut short 2024- there is lots of resentment with us. In 2022, I saw messages that he exchanged with another lady colleague on romantic songs , good morning messages and they would casually meet for lunch etc . This time I flew in rage and assumed he has cheated on me again. Told him first time I was a fool who didn't notice things right under my nose and now this is the latest. We had a big fight. I reminded him of his dirty past. At first he looked shocked from these allegations and told me he will clarify everything later. But next day in 2022 , when I asked him, he appeared to be a changed man and sounded more confident that he didn't do anything wrong. I pestered him to take me to office, we went to his office I met this lady and politely told her to stop sending good morning messages to my husband. I indirectly told her I have trust issues because of a past but did not elaborate. My husband who had taken me to the office , later was annoyed because apparently the woman colleague was annoyed about me coming to office and also mentioned about my trust issues. At this point this great husband spilt out to her that he had cheated on me. I never ever disclosed anything to her. Later he messaged me saying he was very annoyed and upset that I disclosed the dirty past to his colleague and if anything happens to his job he will never forgive me. I did tell him I never disclosed but he did not belive me. From 2022 until now we are almost in a silent divorce phase. We sleep in different bedroom and only communicate basic stuff on milk, curd , veggies etc He had never connected to me emotionally and would always get annoyed when I wld cry or show my frustrations. Now after all this he has literally cut me off emotionally. In this period from 2022-till now I did try to get back to normal but his vibes are very negative and disconnected. So even I too started distancing myself. During 2022, after the incident he had mentioned on how it is important to work, ve independent and how he favours open relationships ( non sexually). I was always working but earned lesser and used to depend on him a lot. Now I have changed in these 2 years, I have a better job and am not at all dependent on him emotionally, physically or mentally. Infact I pitch in to our household expenses.Our lives are totally disconnected and we there just for the kids. He cooks for all of us, I take care of remaining chores and help them in their studies . We don't attend family events and this has left many guessing on our status. I have lot of unresolved emotions and since he cannot process my emotions or least interested to hear me out I don't know when I will explode. I am just repressing my feelings and keeping a happy cheerful face for the family and kids. We even went for a vacation for kids sake where we just interacted with kids. Kids know things are not allright and pray for us together. I know this isn't healthy for me and I will invite psychosomatic issues in life later on. I am still attached to him and maybe once he expresses a sorry or a remorse and have a hope we can fall back in love again. Why can he never understand that emotional trauma that I have gone through Inspite of being loyal to him always. For once if he just uses kind words and apologises I will forever love him and forget everything.
Ans: Dear Anonymous,
Your husband perhaps is someone who is not great at conflict management; he finds it easier to avoid it and avoidance can mean that he hopes that it will go away or that you will stop talking about it or that he can find ways of actually pinning the blame on you for the way that he is feeling.
So, you will come across as nagging and may also feel guilty for asking him to listen to the way that you feel about the past incident. This is classic avoidance response from him that will make you wonder of you are actually wrong and at some point you may even start justifying his actions.
Repression is temporary; eventually all the emotions will collect themselves and hit back when you least expect it. If you want him to hear you and the way you have felt about his cheating, he will again get pushed into an avoidance mode. He has not learned any other way of handling conflicts. So, either you can go to couples counseling together OR you accept this side of him. Sounds too much to do, yeah? But how can you change a person who does not want to change. Some people also cannot express their love the way you have mentioned.
Since you still love him, I can only assume that the marriage holds a lot of significance for you. Then you can be happy only when he changes OR you accept him... which one seems more doable, start with that first...who knows if an external person like an expert can actually guide the two of you, things may fall in place!
I would also suggest requesting him for an honest chat where he is also in a space to LISTEN to you...try...

All the best!
Anu Krishna
Mind Coach|NLP Trainer|Author
Drop in: www.unfear.io
Reach me: Facebook: anukrish07/ AND LinkedIn: anukrishna-joyofserving/

...Read more

Ravi

Ravi Mittal  |397 Answers  |Ask -

Dating, Relationships Expert - Answered on Nov 06, 2024

Asked by Anonymous - Sep 01, 2024
Relationship
I am a 27 year old female. I am dating a guy for 10+ years, we have become too casual about each other. Its like our relationship has lost the spark after we left college. We are dragging our relationship just because we both arent ready to put efforts in finding new partners. Whenever we meet, we cuddle and sleep and havent had sex since last 2 years. Emotionally we are too close but physical intimacy is kindof lost. Since its time to get married. I am still unsure whether he as of now is the one for lifetime. Should we venture for new partners respectively or are we the one for each other. Please Suggest.
Ans: Dear Anonymous,
If you have to ask "Are we the one for each other?" something must be going really wrong in the relationship. Moreover, you also mentioned dragging it, so reconsidering the relationship can't hurt. There is another option- you can try couple's therapy and get to the bottom of this detachment. It can be time; it happens to many long-term couples. Nothing comes without effort- you will have to work on it every day and explore new things to bring back the spark. If you don't want to let go of this relationship, try these suggestions. But to continue lugging it because this relationship is all too familiar and comfortable now is not the right decision. If it's okay with both of you, take a break and venture out for new partners. See how things pan out. The choice is yours. The only thing that I can confirm is that at this point, you should not rush into getting married and focus on sorting things out first.

Best Wishes.

...Read more

Dr Nagarajan J S K

Dr Nagarajan J S K   |153 Answers  |Ask -

Health Science and Pharmaceutical Careers Expert - Answered on Nov 06, 2024

Listen
Career
My daughter has completed BSc in Life Science and Masters in Microbiology in June 2024. She is searching/applyin for jobs in pharma companies but no success Please guide
Ans: Hi Sir,

I am glad to hear that she has completed her MSc in Microbiology. Could you let me know what type of project she worked on during her final year? Additionally, what skills has she acquired during her postgraduate studies? While eligibility might be determined by her percentage, it's important to note that skills play a significant role in the job market.

Did she complete an internship in the pharma industry? Nowadays, many candidates claim to have experience, but often lack competency in their subjects.

One essential aspect is preparing her resume. She should highlight her skills, any internships she has completed, and the projects she worked on during her postgraduate program.

Industries are currently facing various challenges due to human resource issues, making them cautious in selecting candidates for specific roles.

I also recommend that she consider an internship at Biocon for six months. They have an academy focused on biotech-related training, and completing this prograHi Sir,

I am glad to hear that she has completed her MSc in Microbiology. Could you let me know what type of project she worked on during her final year? Additionally, what skills has she acquired during her postgraduate studies? While eligibility might be determined by her percentage, it's important to note that skills play a significant role in the job market.

Did she complete an internship in the pharma industry? Nowadays, many candidates claim to have experience, but often lack competency in their subjects.

One essential aspect is preparing her resume. She should highlight her skills, any internships she has completed, and the projects she worked on during her postgraduate program.

Industries are currently facing various challenges due to human resource issues, making them cautious in selecting candidates for specific roles.

I also recommend that she consider an internship at Biocon for six months. They have an academy focused on biotech-related training, and completing this program successfully may lead to a job at Biocon, depending on her performance.

All the best! m successfully may lead to a job at Biocon, depending on her performance.

All the best!

...Read more

DISCLAIMER: The content of this post by the expert is the personal view of the rediffGURU. Investment in securities market are subject to market risks. Read all the related document carefully before investing. The securities quoted are for illustration only and are not recommendatory. Users are advised to pursue the information provided by the rediffGURU only as a source of information and as a point of reference and to rely on their own judgement when making a decision. RediffGURUS is an intermediary as per India's Information Technology Act.

Close  

You haven't logged in yet. To ask a question, Please Log in below
Login

A verification OTP will be sent to this
Mobile Number / Email

Enter OTP
A 6 digit code has been sent to

Resend OTP in120seconds

Dear User, You have not registered yet. Please register by filling the fields below to get expert answers from our Gurus
Sign up

By signing up, you agree to our
Terms & Conditions and Privacy Policy

Already have an account?

Enter OTP
A 6 digit code has been sent to Mobile

Resend OTP in120seconds

x