search icon
linner
back arrow Back

Deductible in Comprehensive Health Policy

reply Share
21 Dec, 2023 by  Rudra Chatterjee

I am very confused about this so being a bit elaborate. Sorry for the inconvenience.


Let's say I have a policy of Company A with 10L cover and a deductible of 1L. I got hospitalized. Bill comes out to be 3L, and gets paid by my corporate cover of Company B via cashless. I go home happy.


3 months later I get hospitalized again under emergency. Family gives health card of 10L policy (Company A) to the TPA desk.


My Questions and doubts are as follows:


1) How is Company A supposed to know that I have spent the deductible amount of 1L in my previous Hospitalisation through the corporate cover of Company B (or cash out of pocket)? They can reject the cashless claim outright and ask me to spend 1L first and then come to them.


2) Let's say Company A does not reject the cashless claim and asks for documents to prove that I have spent the 1L deductible. What documents can they possibly ask for and processing of these documents would delay in the initial approval of the cashless claim right?


3) Is there a way to avoid this delay by informing Company A about my previous hospitalization and upload/send the related documents just after discharge so if I do get hospitalized down the line there won't be any hassle for my family members?


4) If any expert has handled a claim like this before and was able to process it via cashless basis then please provide a list of documents I should always keep ready and might be asked by the insurer so that my family does not have to run around.


5) Is the probability of cashless getting rejected for a policy with a deductible option very high? Should I even go for this option?


Thanks for reading and the replies in advance.

like
0
Health Insurance
Claim

1 Answer

Post
17 Jan, 2024

Hello Rudra,

Answering your questions one by one:

1) How is Company A supposed to know that I have spent the deductible amount of 1L in my previous Hospitalisation through the corporate cover of Company B (or cash out of pocket)? They can reject the cashless claim outright and ask me to spend 1L first and then come to them.

- You will have to submit proofs to the insurance company that you have already paid the 1 Lakh deductible threshold. Once you have submitted the document the insurance company will be verifying the documents. Rejecting or accepting the cashless claim will completely depend on the insurance company.

2) Let's say Company A does not reject the cashless claim and asks for documents to prove that I have spent the 1L deductible. What documents can they possibly ask for and processing of these documents would delay in the initial approval of the cashless claim right?

-The insurance company may ask for all the original bills that you might have of the previous hospitalization, your discharge summary, the reports etc. The delay of the process will completely depend upon the insurance company.

3) Is there a way to avoid this delay by informing Company A about my previous hospitalization and upload/send the related documents just after discharge so if I do get hospitalized down the line there won't be any hassle for my family members?

-As far as I know you will still have to submit the documents at the time of claim even if you have submitted the documents previously to the insurance company.

4) If any expert has handled a claim like this before and was able to process it via cashless basis then please provide a list of documents I should always keep ready and might be asked by the insurer so that my family does not have to run around.

- Few of the documents that you will have to keep ready will be as follows:

-Discharge Summary

-Copy of Bills

-Copy of Reports

This may differ according to the plan that you have. You will find the complete list of documents in your policy schedule.

5) Is the probability of cashless getting rejected for a policy with a deductible option very high? Should I even go for this option?

-Not necessarily, this may depend upon case to case basis.

Thanks.

like
0
icon-comment 0 Comments
icon-reply Reply

Tired of dealing with call centers!

Get a professional advisor for life!

LIFETIME FREE

Rs. 1799

or