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Health Insurance claim settlement

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27 Jul, 2021 by  Ambuj Nema

Hi Experts,


I just had a claim settlement for health insurance which I applied for my father, but I see lot's of deductions happened (like Hospital Service Charges, Pre and Post hospitalisation charges).

I am not happy at all looking at the deduction, can you please tell me what is the next steps I can take and how can I get more information about what should be deduction actually?


Thanks and Regards,

Ambuj

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Health Insurance

1 Answer

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27 Jul, 2021

Dear Ambuj,


First, you should carefully read your policy document and understand about the exclusions.


Hospital service charges, registration charges, admin charges, and cost of non medical items are usually excluded in health insurance. Pre & Post hospitalization expenses are covered if the expense is incurred on an item directly related to the cause of hospitalization.


If you feel your claim has been unfairly denied, you can write to the Grievance Head of your Insurer. Their email ID will be available on Insurer's website as well as on IRDAI's website.


Next level of escalation is IRDAI's integrated grievance management system.


If you don't get satisfactory resolution even here, your final resort is Insurance Ombudsman. Details of Insurance Ombudsman are also available on the IRDAI website.


FYI, there are now some professionals who specialize in claims advisory. I know 2 such people on this forum - Anuj Jindal of Sureclaim & Shailesh Kumar of Insurance Samadhan. You can email to them at anuj@sureclaim.in & corporate@insurancesamadhan.com


Good Luck!


Asad Akbar

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