It is quite common for those claiming health insurance to be disappointed when the entire claim amount is not honoured by the insurer. (Representational image)
It is quite common for those claiming health insurance to be disappointed when the entire claim amount is not honoured by the insurer. To avoid such a situation, you should be clear on what exactly is covered by your insurance provider. If you know your sub-limits of hospital room rents, co-payment clause, and general exclusions, you can not only avoid disappointment at not receiving the full claim but also make optimum use of your health insurance. Finding the right hospital for you and preparing for an emergency is a largely ignored facet of medical planning.
Here, we take a look at six such ideas to help you squeeze the maximum out of your health cover and prepare you for most eventualities.
Plan your hospitalisation: Medical emergencies apart, it is always a good idea to plan your hospitalisation in advance to make the best use of your health plan. Compare the cost of treatment in various hospitals, check out the details of your treatment including the time you will be spending in the hospital, and select the most cost-effective hospital for your treatment. For expensive surgeries, the cost difference between hospitals can easily run into big numbers, so selection of hospital must be taken seriously.
Choose closest hospital: While choosing hospital from the network of hospitals available with the insurer, it may be sensible to choose the one which is close to your home. This would allow you to cut down the high costs of emergency travel, transportation, and lodging. Also, most health insurance plans have a cap on ambulances charges, so the nearer the hospital is from your residence, the lower your charges.
Compare costs among network hospitals: If you are choosing a hospital only because it is suggested by your doctor, there may be unforeseeable consequences. Doctors may have tie-ups with hospitals depending on which ones they visit or are empaneled on. If you opt for a hospital that the doctor recommends, you may not only lose out on cashless hospitalisation benefits, but also end up paying a higher amount for your treatment, etc. A more optimal approach is to compare detailed costs among your preferred network hospital and the hospitals suggested by your doctor and then take a final call.
Inform hospital in advance: You must initiate your correspondence with your insurance provider as soon as you know that you will be hospitalised. In case of cashless payments, you can fill up the pre-authorisation form at the hospital to get a quick clearance for the insurer. But failing to intimate the insurer within the time stipulated in your policy could create problems while making insurance claims.
Know when to use daycare versus inpatient facility: Advanced medical technology has enabled many surgeries once considered complicated are done in a day-care procedure today. This means that you are not staying in the hospital overnight after your surgery. Your surgery or medical procedure will come under the hospitalisation category only if you are admitted in the hospital for at least 24 hours. So, if you were discharged before 24 hours, and if daycare procedures are not covered in your health plan, your claim could be rejected.
Compare bills with discharge summary: Usually, there is much eagerness by both the patient and his or her family, to go home from the hospital once treated, and understandably so. If you or anyone from your family is being discharged, make sure someone is comparing all invoiced bills with the discharge summary and tally all the details. Any discrepancy or mismatch in invoiced bills and discharge summary may create issues while staking claims since insurers are particular about which category of hospitalisation expenses they will pay for and which they won’t. Opting for a health insurance is a smart decision, but using your health insurance plan wisely is just as essential to avoid any heartbreak over claim denial.