If your claim was rejected because of incomplete information or papers, you can get in touch with the Insurer or the TPA to confirm on the required information
If the hospital rejects my insurance claim saying the papers are not in order what can I do? The hospital is saying there are no more documents to submit and refuses to entertain my case.
- M R Patel
It is mandatory for claimants to submit the required documents for an insurance provider to process the claim. If your claim was rejected because of incomplete information or papers, you can get in touch with the Insurer or the TPA to confirm on the required information. A record of your past medical history and hospital bills should be kept handy for faster processing of claims.
I have a family floater of Rs.5 lakh and I want to buy a top-up cover. Should I buy it from the same insurance company? Should I buy the same amount?
- Rishi Srinivasan
You can buy a top-up policy from the same or different insurance company. Since your existing health insurance is of Rs. 5 lakh, you can opt for a higher sum insured with a deductible of Rs 5 lakh. You get top-up policies with sum insureds ranging from Rs 1 lakh to Rs 50 lakh, with deductible options from Rs 1 lakh to Rs 10 lakh, depending on your need.
I underwent chemotherapy last year and was covered by the group health insurance provided by my office. Now the doctor has recommended a one-year maintenance treatment. After the first claim the insurance company refused to pay saying this treatment is not covered in the policy? I have a separate family floater policy from another company. Can I claim under that? Don’t group schemes usually have more coverage than individual claims.
- Raman Kumar
In such a situation, the employer who provided the group health insurance should pay for the cost of treatment as well, since most of the times, group health insurance provided by the employer comes with a coverage of pre-existing diseases. In case of a separate family floater cover, the expense for the current treatment can be claimed from that policy as well. The insurance company could have refused to pay for the claims (we presume from group policy) considering that the cover for such treatment would be capped with a sub-limit.
Pushan Mahapatra, MD & CEO, SBI General Insurance
Send your queries related to general insurance to personalfinance@dnaindia.net.
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