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Ramalingam

Ramalingam Kalirajan  |8324 Answers  |Ask -

Mutual Funds, Financial Planning Expert - Answered on Apr 05, 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
Chandan Question by Chandan on Jul 07, 2023Hindi
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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.
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.
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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.

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I have been married for more than 21 years and I have 2 kids. 19 and 17 years old. Our marriage was more or less love. Met through family, fell in love, dated 8 months before we got engaged and married. My wife is a lovely lady but we dont share any interests. I used to go for runs in the morning. After getting married, she insisted I sleep late with her. I am a music aficionado and she has no such interest. I am a news junkie. She probably doesnt know who the President of the US is. I am someone who believes and strives to continuously improve myself in all aspects. But she is the same. I might not be a great husband but I am much better than what I was a few years ago. I cook, clean, helped with childcare and have a great career. She is on a minimum salary job for the last 10 years. Only reason she goes is because I insisted that she stop being at home. If she had her way, she would be at home on the phone the whole day. Even our love making has become kind of boring. She claims a period for 10 days and during the other times, twice she is ready. No spicing it up. Just lie down for missionary and I have to do all the effort. I enjoyed oral and now she has stopped in for more than 15 years. I adjusted as she is a lovely person in every other aspect. But now I am sick and tired. It seems I am doing everything in the relationship and she rarely takes any effort. Either to earn, keep house clean or even intimacy. Not sure how to proceed further. I am getting irritated and often in a bad mood.
Ans: Dear Jack,What you're experiencing is not uncommon in long-term relationships: emotional fatigue, feeling unappreciated, and a deep sense of disconnection despite loyalty and love. The fact that you're feeling drained, resentful, and stuck is a clear signal that this situation is unsustainable as is. And the irritation and bad moods you’re having? That’s your emotional system signaling burnout, not failure.

You’ve evolved over the years—mentally, emotionally, and in lifestyle—and it sounds like your wife hasn’t moved in that same rhythm. That mismatch in growth and energy is now affecting everything: your respect for her, your shared routines, your sex life, and ultimately your mood and emotional well-being. It’s painful to feel like you're constantly giving—time, energy, effort—and not receiving the same in return. Even when your partner is kind, if they aren’t meeting you emotionally, intellectually, or intimately, over time it creates a sense of loneliness within the relationship, which can be worse than being alone.

But here's something to reflect on: for 21 years, you stayed, gave, adjusted. Not just out of duty, but because something about her and the family life you built mattered. That still counts. What you’re going through doesn’t mean the marriage has failed—it means the marriage needs re-evaluation and rebalancing. You are not selfish for wanting more stimulation, connection, or passion. You're human.

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Kanchan Rai  |586 Answers  |Ask -

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Ans: Your instinct to save the marriage is understandable. When you're in love with someone, the idea of losing them feels like losing yourself. But let’s pause and ask—what exactly are you saving? Is it the version of him from the early days who was loving and supportive? Or is it the man he is now—disrespectful, distant, manipulated, and asking you to give up your dreams for a marriage he’s already neglecting?

You have already proven your strength by completing a year of M.Tech in such tough conditions. That says a lot about your resilience and capability. If you give it up now, not only will you lose that part of yourself, but it may not guarantee that your marriage improves. Often in emotionally imbalanced relationships, one-sided sacrifices don’t lead to healing—they lead to more control, more blame, and more emotional exhaustion.

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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.

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