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Ramalingam Kalirajan |7550 Answers |Ask -Follow

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

Asked by Anonymous - Apr 02, 2024Hindi

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.

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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Sanjib Jha | Answer |Ask -Follow

Insurance Expert - Answered on Jun 21, 2022

Question by S - Jun 21, 2022Hindi

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.

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Ramalingam Kalirajan |7550 Answers |Ask -Follow

Mutual Funds, Financial Planning Expert - Answered on May 02, 2024

Asked by Anonymous - Mar 27, 2024Hindi