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

Leg Fracture Recovery: Covered by Health Insurance After 4 Years?

Ramalingam

Ramalingam Kalirajan  |7209 Answers  |Ask -

Mutual Funds, Financial Planning Expert - Answered on Jul 25, 2024

Ramalingam Kalirajan has over 23 years of experience in mutual funds and financial planning.
He has an MBA in finance from the University of Madras and is a certified financial planner.
He is the director and chief financial planner at Holistic Investment, a Chennai-based firm that offers financial planning and wealth management advice.... more
Sudhakar Question by Sudhakar on Jul 14, 2024Hindi
Listen
Money

Before ihave accidentally my leg fracture that no insurence after two years get coved time I have health insurance policy taken now fourth year surgery cover

Ans: Health insurance covers medical expenses. It includes hospital stays, surgeries, and treatments. You need to check the policy details.

Coverage for Pre-existing Conditions
Pre-existing conditions are medical issues you had before getting insurance. These conditions often have a waiting period before coverage starts.

Your Specific Case
You mentioned a leg fracture. Since it's now two years old, check if the policy covers it. Most policies cover pre-existing conditions after a specific waiting period. Since your policy is now in its fourth year, it's likely the surgery will be covered.

Action Steps
Review Your Policy: Check the terms for pre-existing conditions and waiting periods.

Contact Your Insurer: Confirm coverage for your surgery.

Plan for Surgery: Ensure all paperwork and approvals are in order.

Future Considerations
Stay Informed: Keep updated on your policy's terms and conditions.

Regular Health Check-ups: This helps in early detection of health issues.

Emergency Fund: Always have some savings for medical emergencies.

Final Insights
Your health insurance is crucial. Ensure you understand its terms and use it wisely. Stay proactive about your health and insurance details.

Best Regards,

K. Ramalingam, MBA, CFP

Chief Financial Planner,

www.holisticinvestment.in
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

Ramalingam

Ramalingam Kalirajan  |7209 Answers  |Ask -

Mutual Funds, Financial Planning Expert - Answered on Apr 16, 2024

Asked by Anonymous - Apr 02, 2024Hindi
Listen
Money
i have tata aig insurence can i get money for reservice of hip joint i had been operated for both hip replacemt done 15 yrs back
Ans: The coverage for hip joint replacement surgery under your Tata AIG insurance policy would depend on the specific terms and conditions of your policy. Generally, health insurance policies may cover joint replacement surgeries, including hip replacement, if it is deemed medically necessary.

Here are steps to determine coverage:

Review Policy Document: Check your Tata AIG insurance policy document to understand the coverage details, exclusions, and limitations related to joint replacement surgeries.

Pre-Authorization: Before undergoing the surgery, it's essential to inform the insurance company and obtain pre-authorization for the treatment. This process involves submitting relevant medical documents and getting approval from the insurer.

Claim Submission: After the surgery, submit a claim to Tata AIG along with all the necessary documents, including medical bills, doctor's prescription, hospitalization records, and pre-authorization approval letter.

Policy Coverage: Review the policy's coverage limit, co-payment, deductibles, and any waiting periods related to joint replacement surgeries.

Exclusions: Be aware of any exclusions related to pre-existing conditions, waiting periods, or specific treatments not covered under your policy.

Claim Settlement: Once the claim is submitted, Tata AIG will review the documents and process the claim as per the policy terms. If the surgery is covered under your policy, you may receive reimbursement or cashless treatment as per the policy terms and conditions.

Alternative Coverage: If the joint replacement surgery is not covered under your current policy or the coverage is insufficient, consider exploring additional health insurance options or upgrading your existing policy to include better coverage for such treatments.

It's crucial to read the policy document carefully and consult with Tata AIG customer service or your insurance agent to understand the coverage details and claim process related to hip joint replacement surgery. Remember to keep all the medical records and bills safely for claim submission and reimbursement.

..Read more

Ramalingam

Ramalingam Kalirajan  |7209 Answers  |Ask -

Mutual Funds, Financial Planning Expert - Answered on Jul 12, 2024

Listen
Money
my car met an accident with a person 3 month ago. my car had collied with a boy and boy get minor injury. we did not log any police complaint at that time, but call insurance compnay. later i paid expanse of the treatment of the boys injury. i have 3rd party insurance also. now please let me know how can i claim of the treatment expanse from insurance company. if they will pay to the injured person, i am ok to it.
Ans: I’m sorry to hear about the accident and hope the boy is recovering well. It’s great that you took responsibility for his medical expenses. Since you have third-party insurance, you can potentially claim the treatment expenses from your insurance company. Here’s how you can proceed:

Steps to Claim Treatment Expenses from Third-Party Insurance
1. Gather Necessary Documents
Ensure you have all the necessary documents ready, including:

Insurance Policy Details: Your third-party insurance policy
Accident Details: Date, time, and location of the accident.
Medical Bills and Receipts: Copies of all the treatment expenses you paid for the injured boy.
Medical Reports: Any medical reports or discharge summaries from the hospital.
Witness Statements: If possible, get statements from any witnesses of the accident.
2. Inform Your Insurance Company
Contact your insurance company as soon as possible. Provide them with the details of the accident and the treatment expenses incurred. Inform them that you wish to claim these expenses under your third-party insurance.

3. Submit a Claim Form
The insurance company will provide you with a claim form. Fill out the form accurately, providing all necessary details. Attach the gathered documents, including medical bills and reports, with the claim form.

4. Cooperate with the Investigation
The insurance company may conduct an investigation to verify the details of the accident and the incurred expenses. Cooperate with their inquiries and provide any additional information or documents they may request.

5. Follow Up
Keep in regular contact with the insurance company to follow up on your claim status. This will ensure that your claim is processed promptly.

6. Payment to the Injured Person
If the insurance company agrees to cover the expenses, they may pay the amount directly to the injured person or reimburse you for the amount you have already paid. Confirm this with your insurance company and provide the injured person’s contact and bank details if needed.

Points to Remember
Document Everything: Keep copies of all communications with the insurance company, including emails, letters, and phone call records.
Legal Advice: If you face any difficulties in the claim process, consider seeking legal advice to ensure your claim is processed smoothly.
Possible Outcomes
Reimbursement to You: The insurance company reimburses you for the medical expenses you have already paid.
Direct Payment: The insurance company pays the medical expenses directly to the injured person or their family.
By following these steps, you can navigate the claim process with your third-party insurance company and ensure that the medical expenses are covered. Your proactive approach in taking responsibility for the injured boy’s treatment is commendable and should help in facilitating a smooth claim process.

Best Regards,

K. Ramalingam, MBA, CFP,

Chief Financial Planner,

www.holisticinvestment.in

..Read more

Ramalingam

Ramalingam Kalirajan  |7209 Answers  |Ask -

Mutual Funds, Financial Planning Expert - Answered on Jul 25, 2024

Listen
Money
Hi sir good evening hip replacement surgery cover by health insurance plz help me
Ans: Health insurance policies typically cover various medical procedures, including surgeries. Hip replacement surgery is a significant medical procedure, and understanding its coverage under your health insurance is crucial. Let’s break it down.

Coverage for Hip Replacement Surgery
Inclusion in Policies

Major Surgeries: Most comprehensive health insurance plans cover major surgeries, including hip replacement.

Hospitalisation Costs: Covers hospitalisation expenses, including room rent, doctor fees, and nursing charges.

Pre- and Post-Hospitalisation

Medical Tests: Pre-hospitalisation expenses, like diagnostic tests, are often covered.

Follow-Up: Post-hospitalisation expenses, such as follow-up visits and medications, are typically included.

Checking Your Policy
Policy Document

Terms and Conditions: Review your health insurance policy document for specific coverage details.

Exclusions: Look for any exclusions related to hip replacement surgery.

Customer Support

Insurance Provider: Contact your insurance provider’s customer support for clarification.

Detailed Information: Ask for detailed information about coverage limits and conditions.

Additional Considerations
Waiting Periods

Initial Waiting Period: Check if there is an initial waiting period before you can claim for surgeries.

Specific Waiting Period: Some policies may have a specific waiting period for certain surgeries.

Co-Payment Clause

Shared Costs: Some policies have a co-payment clause, where you pay a part of the expenses.

Percentage: Understand the percentage you need to co-pay.

Disadvantages of Index Funds
Lack of Flexibility

Fixed Portfolio: Index funds have a fixed portfolio, limiting flexibility.

Underperformance: They may underperform compared to actively managed funds.

Benefits of Regular Funds
Professional Management

Expertise: Managed by professional fund managers.

Higher Returns: Potential for higher returns compared to direct funds.

Importance of a Certified Financial Planner
Expert Guidance

Personalised Advice: Provides tailored advice based on your specific needs.

Continuous Support: Offers ongoing support and adjustments to your financial plan.

Final Insights
Review Your Policy: Always review your health insurance policy for specific coverage details.

Seek Professional Help: Consider consulting with a certified financial planner for expert guidance.

Stay Informed: Stay informed about your policy terms and conditions to avoid surprises.

Best Regards,

K. Ramalingam, MBA, CFP,

Chief Financial Planner,

www.holisticinvestment.in

..Read more

Latest Questions
Dr Anshuman

Dr Anshuman Manaswi  |6 Answers  |Ask -

Plastic-Aesthetic Surgeon, Emergency Care Consultant - Answered on Dec 05, 2024

Asked by Anonymous - Dec 05, 2024Hindi
Listen
Health
Dear Doctor, I work as a corporate lawyer in Delhi. I’ve been considering undergoing a cosmetic procedure for my skin for some time now, but I’m feeling a bit overwhelmed by the number of surgeons available. I want to ensure that I choose someone who is experienced, as this is a big decision for me. Could you advise what I should look for when selecting a plastic-aesthetic surgeon? Are there any specific red flags I should be aware of when researching potential surgeons? I want to make sure I’m in safe hands. I’m 40 years old.
Ans: This is a beautiful question.
Before I dwell on your question, there are a few points which are very important for the patient to know.
1. You should roughly know what result you wish to have.
2. Never think of a perfect result. There is no such result.
3. You must think in terms of improvement and if you are sble to achieve more than 90% approx, it can be considred good.
4. Dont compare your results with any celebrity's result. There body structure is different, they have probably taken better care till now and importantly, the result you see on a public platform is after make up and not the real result. Some times it may be a photoshopped image
5. Let your doctor know if you have any medical history and addictions.
6. Don't go with pre concieved notion (especially if you have researched a lot online). Discuss with the doctor, listen to his/ her views and raise your concerns if any
7. Try and see some results of the doctors work (Remember, too good a result may not be the true result). Realistic result is what you should want to look at and believe.
8. Don't fall for less budget! its obvious a meticulous job needs more surgical time. This means that the doctor may charge more. Seniority also adds to the cost.
What I mean, there is a price to be paid for a good job.(whether medical or anywhere).
Now coming to the Plastic surgeon's choice.
1. Research well, but dont fall prey to only advertisement. Small and big centers, both advertise,
2. Dont fall for glamour. You are going to a surgeon. A plastic surgeon's clinic is clean but not lavish generally. At least I believe that the person coming is not a client, but a patient. A patient - Doctor relationship is more pure than a client-Professional relationship.
3. Talk and discuss with the doctor. A too busy doctor may not always be the best doctor for you. Plastic surgery is about thinking, planning and execution. A doctor who thinks aloud about your problem ( especially if ut us face, nose, breast etc) is applying his/ her knowledge for your betterment, because every oerson is different.
4. Check the resilts? Look for genuinity.
5. Be wary of arrogant, loud and boisterous people. There is a difference between confidence and fambloyence.
6. Doctors who are attached to reputed hospitals are generally good in their work.
7. A doctor who can talk about probable complications is also a doctor worth trusting.
I hope I am able to do justice to this difficult question. All the best. You can write again if you need any other clarifications.
Dr. Anshuman Manaswi

...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