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Sanjib

Sanjib Jha  | Answer  |Ask -

Insurance Expert - Answered on Nov 28, 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
Chiraag Question by Chiraag on Nov 28, 2022Hindi
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Good evening! I have gone through your answers on reading getahead. I have question for “AYUSH” for which I’m paying premium and the insurance company is not advising how to make claims for my Homeopathic treatments where I’m being charged special premium for “AYUSH”.

The insurance company is asking me minimum 24 hours of admission to claim. Unfortunately, there’s no facility for Homeopathy Treatment Hospitalisation. I request you to please share your knowledge on the same.

Ans: Hi Chiraag, hope reading my answers cleared your doubts. To answer your personal query, the insurance company must have mentioned in your policy document that to raise a claim under your policy, you will need to be admitted for minimum 24 hours and without that the claim will not stand.

Also, the treatment in this case needs to be done in an AYUSH recognised hospital to avoid failure of claims.

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

Sanjib Jha  | Answer  |Ask -

Insurance Expert - Answered on May 31, 2022

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This is Bobby here and have a few questions related to your article (enclosed), Mediclaim: What You Must Know Would like to know, with your experience in this field, as to: 1. Which mediclaim policy or policies, currently in INDIA and especially Mumbai has all the required coverage as mentioned in your article 2. We are a family of 3 with a school going child and both of us are aged 45 3. Have acquired diabetes a few months ago and have hepatitis B and kidney stones  4. What should be the approximate premium, per annum to cover all that is mentioned in your article and keep us safe from the issues arising out if and when we really require hospitalisation and save us from rejected claims.   5. Presently we are covered under Mediclaim policy from Star Health Would be highly obliged should you guide us on the above to make our lives easier.
Ans: Hi Bhupesh, there is no ‘one size fits all’ concept with health insurance. Health insurance is based on preferences of the customer and then the premium quotes are generated based on those factors. You can use insurance broking websites to compare the offerings on the mentioned 5 factors and the premiums for various policies that will help you to compare their benefits and make an informed choice. Depending on your priorities, weigh out the factors and decide accordingly.

Since you have mentioned about your family, you can opt for Family Health Insurance policies with an appropriate sum insured to cover your entire family. Like I have mentioned before, premiums are unique to individuals depending on their preferences, the sum insured they deem suitable, the riders they choose, their medical history etc.

What you can do to ensure you buy the correct policy for yourself is to evaluate policies carefully, keeping in mind the 5 important parameters.

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Moneywize

Moneywize   |82 Answers  |Ask -

Financial Planner - Answered on Jan 16, 2024

Asked by Anonymous - Jan 15, 2024Hindi
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How do I make a claim in case of an insurance event? I have a cashless mediclaim from United India but somehow I am not able to understand how I should initiate a claim settlement in case of hospitalisation. Could you please give me step-by-step procedure for filing claims and reimbursements?
Ans: Certainly! The process for filing a claim for cashless mediclaim with United India Assurance may vary slightly based on the specific policy and the nature of the medical event, but here is a general step-by-step guide that you can follow:

1. Inform the Insurance Company:

In case of planned hospitalisation, inform United India Assurance in advance. For emergencies, inform them as soon as possible.

2. Verify Network Hospitals:

Ensure that you are admitted to a hospital that is within the network of hospitals affiliated with United India Assurance for cashless claims.

3. Pre-Authorisation Process:

For planned hospitalisation, you need to obtain pre-authorisation from the insurance company. This involves submitting relevant documents such as the doctor's recommendation, estimated medical expenses, and other required information.

In an emergency, if pre-authorisation cannot be obtained in advance, inform the insurance company at the earliest opportunity.

4. Collect Necessary Documents:

Gather all relevant documents, including the policy document, ID proof, claim form, medical records, hospital bills, diagnostic reports, and any other documents required by the insurance company.

5. Submit Claim Form:

Fill out the claim form accurately. You can obtain this form from the hospital, the insurance company's website, or their customer service.

6. Submit Documents to the Hospital:

Provide the necessary documents to the hospital's insurance desk. The hospital will then submit the claim form and documents to the insurance company for processing.

7. Approval/Rejection of Claim:

The insurance company will review the submitted documents and decide whether to approve or reject the claim. If approved, the insurer will directly settle the bills with the hospital.

8. Paying Non-Covered Expenses:

If there are any expenses not covered by the insurance policy or if the claim is rejected, you may need to settle those directly with the hospital.

Reimbursement Claims:

• If you paid the medical expenses out of pocket, you can file for reimbursement
• Obtain all original bills, receipts, and medical reports
• Fill out the reimbursement claim form
• Submit the form along with the supporting documents directly to the insurance company within the stipulated time frame.

Follow-Up:

• Keep track of your claim's status by following up with the insurance company if necessary.
• Retain copies of all documents submitted for your records.

Always refer to the specific terms and conditions of your insurance policy and contact United India Assurance's customer service for any policy-specific details or clarifications. The contact information for United India Assurance can typically be found on their official website or in your policy documents.
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Moneywize

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Financial Planner - Answered on Mar 18, 2024

Asked by Anonymous - Mar 17, 2024Hindi
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Why do third party agents hesitate to reimburse genuine health expenditure incurred on ayurvedic treatment {all conditions fulfilled including admission in ayurvedic hospital}. All proofs submitted. What should I do if the TPAs don't process my claims for ayurvedic treatment?
Ans: There are a few reasons why third party administrators (TPAs) might hesitate to reimburse genuine health expenditure incurred on Ayurvedic treatment, even if all conditions are fulfilled and proofs are submitted.

• Ayurveda is not mainstream medicine: While Ayurveda is an ancient and recognised form of medicine in India, it is not considered mainstream medicine by some insurance companies. This means that TPA might not have clear guidelines for processing and approving Ayurvedic treatment claims.
• Lack of standardisation: There can be a lack of standardisation in Ayurvedic practices and treatments. This can make it difficult for TPAs to assess the validity and legitimacy of a claim.
• Cost-containment: TPAs work for insurance companies, and insurance companies are in the business of making money. This means they may be looking for reasons to deny or delay claims. Ayurvedic treatments can sometimes be expensive, and TPAs may be looking for ways to control costs.

Here are some things you can do if your TPA is not processing your claims for Ayurvedic treatment:

• Review your policy documents: Carefully read your insurance policy documents to understand the coverage for Ayurvedic treatment. Look for exclusions or limitations that might apply.
• Contact your TPA: Call your TPA's customer care department and ask them to explain why your claim was denied. Be polite but persistent in getting answers.
• File an appeal: If you are not satisfied with the TPA's explanation, you can file an appeal. The appeal process will vary depending on your TPA, but there should be information on how to file an appeal in your policy documents or on the TPA's website.
• Contact your insurance company: If the appeal process is unsuccessful, you can contact your insurance company directly. Explain the situation and ask them to intervene on your behalf.
• Consider legal action: If all else fails, you may want to consider taking legal action against your TPA or insurance company. This should be a last resort, as legal action can be expensive and time-consuming.

Here are some resources that you may find helpful:

• The Insurance Regulatory and Development Authority of India (IRDAI) is the regulatory body for the insurance sector in India. The IRDAI website has information on filing complaints against insurance companies and TPAs https://irdai.gov.in/.
• The Consumer Affairs Department of the Government of India also has a website where you can file complaints against companies https://consumerhelpline.gov.in/.
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Anu

Anu Krishna  |773 Answers  |Ask -

Relationships Expert, Mind Coach - Answered on Mar 29, 2024

Asked by Anonymous - Mar 28, 2024Hindi
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I am 65 years old and have history of sleeplessness and on tranquilizers. about two years back, it got so bad that one night I wanted to end it all. fortunately my wife was around and calmed me down. We saw a psychiatrist the next day and she put me on anti depressants. Since then I am sleeping well. But the fear is I feel I will not sleep without medication. Is it okay to take this medication life long. Is there a way I can go to sleep without medication like everybody else? allthough I am a diabetic my general health is good as I take part in endurance running and related activities.
Ans: Dear Anonymous,
You need medicines to sleep and now you worry that without that you worry that you won't sleep. That's how these medicines can be...make you dependent on them...
The better choice will be to grow out of them...any kind of dependence of anything or anyone is never healthy.
Speak with your doctor and state that you do not want to be dependent on medicines for something as natural as sleep...He/She will suggest ways to wean you off from the medicines and also hoping that they put you on some holistic treatment like meditation or other any alternative therapies that are known to eliminate the source of sleeplessness in you.
Be patient with this line of treatment as it will take time to identify the root of the problem but once it is found, it becomes easy to treat it once and for all hopefully taking you off medicines fully someday.
Kindly explore this option as this will help you to take charge of your life and sleep as well.

All the best!
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Anu

Anu Krishna  |773 Answers  |Ask -

Relationships Expert, Mind Coach - Answered on Mar 29, 2024

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my husband died when my son is12.5yrs. he was fond ofcricket and after my sons birth he trained him my son is now 15 he is spineer and play verywell. secondly after my son sbirth he always with my son because he left job and taken vrs. i m single mother now. my son didnot cry cry when he dead nor whenever i talked withhim he didnot want to discuss about him . he irritate. and never from his side he talked about his papa. why i didnot understand. and what to do so that he will talk about his papa. iknow he has verygood memories with him he alawys pamper my son when he was alive. suggest what to do
Ans: Dear Shobha,
I am truly sorry for your loss...Loss of a loved one is one of the toughest phases in anyone's life!
Also, you must understand that each of us have a different way of dealing and coping with loss. Your son possibly feels more comfortable masking his sadness and not talking about how much he misses having his father around. Since you say that he has good memories of his father, spend time with him not discussing his father but actually playing on those memories and keeping those happy memories alive. Since, they bonded over cricket, talk more about that with him and how his father would have been proud of him now. Someday, when he is ready to talk about his father, he will...give him time and replay the good times as a family and especially cricket with his father.
The only time you need to be concerned is when he starts to show any signs of withdrawal from life in general...since you haven't mentioned this, I assume that your son is fine and is just not willing to discuss his father. Let him be...each of us process grief differently. Just bond with him as a caring mother that you are...that will keep him safe and stable.

All the best!
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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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