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

Sanjib Jha  | Answer  |Ask -

Insurance Expert - Answered on Nov 24, 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
K Question by K on Nov 24, 2022Hindi
Listen
Money

I have a Mediclaim insurance policy (senior citizens) from National Insurance co Ltd. My wife was operated for Knee replacement surgery. Against the claim of Rs 3.48 lakh, the claim was passed for 51000/- only. I wrote to the Insurance co and wanted to know the reason but no answer. I seek your help and guidance.

Ans: Hi KD, hope your wife has recovered. To answer your query, I advise you to check your policy document again. There are many health insurance policies that have capping/limitations on the list of ailments. You can find the same in the policy documents or policy wording.

I suggest you approach your insurance company and inquire about the same and if you still fail to get a response from them then you can approach insurer ombudsman for this issue.

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 Jun 21, 2022

Listen
Money
I have mediclaim policy from Oriental Insurance Co since 1992 for 5 lakhs and other from New India Assurance for 7.5 Lakhs under SCUM scheme with my spouse. However both the policies have set a limit of Rs. 40,000 for Cataract surgery even though I have been diagnosed with 1) Cataract Phaco with Panoptix IOL, 2) Pupilloplasty, 3) CTR Implantation for which a renowned hospital billed me as below for separately for each eye. 1) Cataract Procedure Cost. Rs. 27000/- which is approved by Oriental in their contract with Hospital 2) IOL Cost Rs. 49000/- 3) Pulilloplasty Rs. 6950/- after discount 4) CTR Implantation Rs. 1600/ after discount Now in Claim No. 1 Oriental approved. Rs 36,000/- Only and balance Rs 48500 I had to pay Claim No. 2 Oriental approved Rs.73,300/- Only and balance Rs.11250/- I had to pay Surgery was done 1 week apart. In my case I was advised Cataract with multifocal IOL + Pupilloplasty + CTR Implantation So, I need your advice on: How can Insurer Oriental approve and give different claim amount for each eye and how can I claim for reimbursement of balance amount I had to pay. Appreciate your guidance and help.
Ans: Hi Jyoti, hope you are doing well. As you have mentioned that the claim amount for each eye has been different, to understand the reason behind this disparity, you will have to check the documentation submitted to the insurer for both the surgeries. Request you to contact your insurance advisor and discuss the same with the insurer to understand this gap further and help you resolve this issue. 

:

..Read more

Ramalingam

Ramalingam Kalirajan  |6971 Answers  |Ask -

Mutual Funds, Financial Planning Expert - Answered on May 11, 2024

Listen
Money
I have bought a Health Insurance for My family 2+1 on Aug 23 with a 25Lacs covering from Reliance General Insurance Co. This Policy is port from Niva Bhupa which i had taken in 2021. I come to know some one from my surrounding is that the Reliance is not settling claims Properly and full. This policy is taken for 2year. Can u Suggest me
Ans: I understand you're concerned about Reliance General settling claims properly. It's good to be aware! Here's how we can approach this:

Claim Settlement Ratio (CSR) Check: Every insurance company has a CSR, a public record showing the percentage of claims they settle. You can check Reliance General's CSR online to see their historical performance.

Policy Review: Review your policy documents carefully. Understand the terms and exclusions related to claim settlements. If something seems unclear, reach out to Reliance General for clarification.

Network Hospitals: Using network hospitals within your policy can streamline the claim settlement process.

Remember, a single experience doesn't represent the entire picture. However, your concern is valid. Let's not worry, we can assess further!

You did well porting your policy! Health insurance is crucial, and you've taken a great step for your family.

Moving forward: If you'd like a more in-depth analysis of your health insurance options, consider consulting a Certified Financial Planner (CFP). They can assess your specific needs and recommend the best plan based on your family's requirements.

Best Regards,

K. Ramalingam, MBA, CFP,

Chief Financial Planner,

www.holisticinvestment.in

..Read more

Latest Questions
Dr Dipankar

Dr Dipankar Dutta  |678 Answers  |Ask -

Tech Careers and Skill Development Expert - Answered on Nov 05, 2024

Dr Dipankar

Dr Dipankar Dutta  |678 Answers  |Ask -

Tech Careers and Skill Development Expert - Answered on Nov 05, 2024

Anu

Anu Krishna  |1269 Answers  |Ask -

Relationships Expert, Mind Coach - Answered on Nov 05, 2024

Listen
Relationship
Hi Madam, I'm 60,retired, my wife is 47, our son is 23. I had love marriage and was leading a happy married life. Just after silver jubilee of our wedding anniversary I accidentally came to know that my wife is madly in love with one of our common married friend who runs a simple shop. Upon investigation I found that they are in relation for last 12 years and were enjoying sex in my own house for such a long time. He hails from an uneducated family and is not even cultured. I could not believe that the wife of a highly educated socially respected man could do this with a shopkeeper who does not have any socio economic status. I am living a normal life with my wife for the sake of our only child. Once he settles in life I have decided to end my life. Ofcourse I still love her as ours was a love marriage. I seek your wise suggestion in this regard, should I divorce her or live a normal life that we are doing?
Ans: Dear Shristi,
It is obviously very shocking for you to know that things have been happening behind your back.
Now, how you want this to move on from here on, is a decision only you must make! Have you had a chat with your wife about the association that she has with the other person? Does she know that you know about it?
If she doesn't, then you need to make her aware and yes, do ask her whether she is interested at all in the marriage. That will give you an idea as to whether things are worth fighting for or is it best to walk away!

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  |1269 Answers  |Ask -

Relationships Expert, Mind Coach - Answered on Nov 05, 2024

Asked by Anonymous - Nov 03, 2024Hindi
Listen
Relationship
Hello madam I a 32 year old married man with a kid , who is 6 years old. I have done arrange marriage with my own decision I agreed to my parents for the marrige at that time I was in a casual relationship with a girl I didn't said anything to the girl and get married to someone else. After that I tried to live a happay life with my wife without thinking about the girl whom I left behind, from outside I tried to be happy with my wife but my wife thought doesn't matches with me so I felt so disturbed from inside. Still I was trying to continue the relationship for sake of our child but suddenly I got my ex love contact and I was so happy that after so long time I got a chance to talk to her, I have tried to meet her but she always refused to meet me because she was in a relationship. I tried many times and due to some misconduct I again lost her for the second time. At this moment when she is not with me her thoughts memories are troubling me so much I am in pain, what am I suppose to do to get rid of the pain?? Please help
Ans: Dear Anonymous,
There is no point wanting a 'past' relationship just because you have one...what if that relationship did not exist, you would have possibly made efforts to make your marriage work, right?
Then do just that...DO NOT treat your marriage as an option...which marriage is a perfect one? And are all spouses tailor-made to fit one another?
So, if her thoughts don't match with yours, then even yours don't match with hers...so, should she also think of jumping into some other relationship. Please act mature about this especially with a child in the entire equation; try and understand each other...speak about your differences and find ways of working on them by accepting them. Ex-love etc looks all very nice, but come down to ground reality; please...work on your marriage!

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  |395 Answers  |Ask -

Dating, Relationships Expert - Answered on Nov 05, 2024

Asked by Anonymous - Sep 15, 2024Hindi
Listen
Relationship
I am 50 years old and got married 15 years ago. I am a very spontaneous sort of a guy and enjoy life, partying etc. I was also very active socially.My wife being the complete opposite put a stop to all that once we got married. She also does not display any affection and has no interest in physical intimacy. She is just concerned with her housework.We also have lot of differences in mental attitude & intellectual abilities. At no stage will we ever seperate, however, I am unhappy with her nature. She has lot of friends, however is always at daggers drawn with in her in laws. We had to stay separately for 6 months, and I tried looking for love else where, however after a couple of months, I realised, that I missed her. I am in a quandary. Despite requesting her to work on our relationship, I get no response. Please advise on how to proceed.
Ans: Dear Anonymous,
I understand you are in a tough spot. But it's nice to see that after all those years of differences, you still have genuine feelings for her. I strongly suggest considering marriage counseling. From your description of your marriage, it seems to be there have been issues from the very beginning of it. It's been too long and now those issues must've become deep-rooted. Seeing a professional can be a game-changer. They can guide you out of this slump more methodically and help you navigate the emotions you are feeling right now. It can also help you understand the reasons for your wife's disinterest and handle it better.

Best Wishes

...Read more

Ravi

Ravi Mittal  |395 Answers  |Ask -

Dating, Relationships Expert - Answered on Nov 05, 2024

Asked by Anonymous - Nov 02, 2024Hindi
Listen
Relationship
Hii, I have an love marriage after 9 years of dating and 6 years, 2 children post marriage, my little one is 11 months old now. My husband has an affair upto chatting to someone in his company, his junior but in different department, when my Lil one was 1 month old, we had in a rough patch then due to child birth and family drama. When I saw it and confronted him, he said he is sorry and won't do it again, we had multiple fights for 3-4 months after then due to same reason, but he mostly listen and consol. It's been a lot of mental torture for me. I love my husband a lot and he is a good person, but sometimes sill I see her msg in his phone asking for small helps or casual msg. She is also married. I am not sure my husband deletes msg or what, I am not able to get over this. Before it, this is was preety much a good relationship. I am highly educated and independent women. I don't want anything form my husband apart from love. What should I do, whenever I tell him I want to just leave and let him have his life, he won't let me somehow. We are having a good physical relationship 2-4 times a week( just to tell where we are). Please help me...I can't overcome that he is making fool of me...
Ans: Dear Anonymous,
I am sorry to hear you are in such a tough spot. I would suggest considering marriage counseling. A professional who can help you both tackle these issues would be helpful in this situation. I understand that it was his mistake and he needs to put the effort to make you trust him again, but since you are still together, you will also have to put in the effort to let it. I know it is difficult and that's where marriage counselor comes in. They can help you navigate these feelings. Moreover, if he is indeed hiding something, therapy can help that come out in the open.

Hope this helps.

...Read more

Ravi

Ravi Mittal  |395 Answers  |Ask -

Dating, Relationships Expert - Answered on Nov 05, 2024

Asked by Anonymous - Sep 10, 2024Hindi
Listen
Relationship
Hi, Me(M38) and wife(F37) happily married for 12 years and blessed with one daughter. Partner(F28)continuing friendship with a person[M] who had crush on her before marriage considered emotional infidelity? Me(M38) and wife(F37) happily married for 12 years and blessed with one daughter. My wife is having friendship (strictly platonic) with a guy from her 10tlh grade (same class). Before our marriage (she may be doing her college, our relationship just started may be 2 weeks) this guy told her he has genuine interest in her and he want to take the relationship further if she wants, she said she is not interested in a relationship and she got committed, she always saw him as a friend, no other feelings for him and we can be friends if you don't bring any romantic interest again. He never took this talk again ever after and happy to be a friend. They are talking as friends. She got married to me. He also got married. They still do chats once in a month. She introduced me to him and visited his home when we visited his city. He also came to our home once (me and my family was there). She used to update me with chat she had with him and the content they are chatting. I am ok with that When we were talking about our school life and college life 2 years before. She said this guy had crush on her during her college days. I asked her, why did not she tell me this info till now. She said it is not purposely, she does not feel the need to do as the person is not in-appropriate with her and continuing as good friend as promised after she rejected his proposal. I don’t want to create any unnecessary issues as I don’t have any felling or so with him. That time I checked their chats completely, it’s about update about their common friends, their recent travel, their job, meditation courses and the books they read recently. I haven’t seen any flirting or romantic message from either of them. So I am perfectly fine with it and had no problems. I recently came to know about the concept of emotional cheating which is very new to me. Before that cheating to me is only flirting, sexeting and physical sex. I have asked for advice in redddit.com in infedility sub forum about emotional cheating/ emotion affair. There persons are advising like even having friendship with someone who had crush on you is emotional cheating as it is indirectly leading them on you. So with an omission of lie he had crush on her and indirectly leading him on you wife was emotionally cheating on you. This is very much equal to cheating. I do have lots of friends in other gender, but no one had crush on me. Does this count as emotional cheating/affair as she did not mention he had crush on her before marriage? I am little depressed and not able to spend quality time with my wife who is in postpartum depression and take care of our daughter properly as before. Do you guys advise me how to navigate this situation?
Ans: Dear Anonymous,
Are you really going to ruin your happy relationship based on some new term you have learned recently? Emotional cheating and many more terms of the kind will come and go, what truly matters is the truth. She is merely friends with this guy and for your peace of mind, you have even checked their conversations- what part of it looks like cheating to you? If tomorrow, some random person projecting their own insecurities claims that a man speaking to a woman is some "new form" of cheating, would you start believing that? My point is that these are just random opinions of some people- it isn't the ultimate truth. The entire context matters. This man had a crush on your wife, she rejected it, and now they are just friends. I find absolutely no misconduct or infidelity in this. The fact that none of your friends had a crush on you does not factor in at all. Moreover, your wife is in postpartum depression- that should be your biggest concern but here you are, giving more importance to the random 2 AM thoughts of some people you don't even know. Please rethink if you are being fair to your wife- the mother of your child.

Best Wishes

...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