God help you if you have to face hopitilisation without a Mediclaim Policy to bank upon. Trust me, medical expenses are hitting the roof in India (but across the world we are reputed as one of the most cheapest and efficient medical service providers)
Everybody is aware that a mediclaim policy reimburses hospitilisation expenses including room charges, nursing, surgery, medicines, etc. The recent entry of TPAs (Third Party Administrators) has rendered mediclaim cashless.
How does that help ? - Well, you don’t need to pay any deposit to the hospital if your TPA approves your hospitilisation ( Now, thats a real big IF and depends on how efficiently you have submitted your requisition for same) Also, your proposed treatment/surgery costs should be well within your mediclaim limits.
A pre authorisation form is available on the internet with all the TPAs like https://medsavegroup.com, https://ttkhealthcareservices.com, https://uiic.co.in etc...
The TPAs are efficient, responsive and quite alert to your calls, e-mails, provided you have all the necessary details like Policy Number, Name of Doctor, Hospital, Details of illness, injury, hospitilisation.
During emergency, you can admit the patient first and inform the TPA (compulsory) within 24 hrs to process your cashless settlement. Denial of the cashless facility, does not mean denial of medical treatment. You can always preserve all the bills of expenses and submit them later to the Insurance Company (now TPA) for re-imbursement.
A word of caution : Always maintain a detailed file of all the past mediclaim policies and premiums paid. WHY ? Because after the advent of these TPAs, there is a lot of mis-communication and passing the buck between the Insurance Company (namely UNITED INDIA, National Insurance, Oriental Insurance) and the TPAs. They will make you run around and ask you to produce details which actually they are supposed to maintain and keep a permanent record of. In the absence of such relevant details, you may have to wait endlessly for your claims to be settled and this defeats the very purpose why a person takes a mediclaim policy for.
I mean during a medical emergency ( who likes to visit hospitals or doctors out of choice ? - its always out of necessity ) would you like to be running around searching for policy documents and past claim records ?
Or would you be involved in taking care of the patient and providing relief to the suffering ?
It is during such times that these TPAs send you on a wild goose chase to hunt for past medical history of the patient and Discharge card of earlier hospitilisations (if any) and old Policy details, like Insured amount, Cumulative bonus, Policy in existence since how many years and other details.
Due to recent computerisation of records, these new born TPAs have details only for about a couple of years. But the Insurance Companies have the older details in physical format lying in their ’Records department’ which is more like the ’Rodents department’ and they are never keen to set foot there for information. And untill and unless the information is provided or declared ’unavailable’ by the insurance company you can be sure of a good merry go round if you are not careful.
All this could take months and by that time you are in a financial crisis. Like all government departments that work at snails pace, its the same with our mammoth insurance companies that are making losses due their incompetency, corruption and irresponsible babu culture.
The advent of private insurance companies have indeed made some difference but as you can summarise from the above (and my personal experience) old habits die hard. Besides, although the new crop of insurance companies are quicker and more efficient, they are a lot more expensive and very particular about your health status at the time of taking of your policy. Every minute detail is run through with a very fine comb. Even a minor deviation in blood pressure could render your future medical claims void if their doctors can link this blood pressure to your present illness. Like maybe you suffer a heart attack 3 years after taking the policy. An irresponsible statement by the attending doctor in his report saying that the patient was having blood pressure since almost 3 years could blow up all your chances of a claim. These days every little ailment can be linked as a cause to any major illness. I have given a very simple example above.
It is best to take a medical cover at the earliest when one is healthy and free of any ailments and keep your policy alive and in force without any lapse. There are no grace periods in mediclaim and Policy has to be renewed before due date.
I hope I have been helpful. Do not hesitate to M2M me if you need any more details or clarifications.
Regards
Raja