Insurance is a highly competitive industry, and there is no doubt that companies are trying to undertake several measures to get their customers. It’s a fight to the finish.
In this field, firms must be innovative. They must have an advantage. They need to demonstrate that their services are suitable for the public. To draw in these consumers, they’ll create exciting offerings. The salespeople will assure you as much. But upon deeper inspection, these product features may not add any value – or worse – be counterproductive to your goals.
To identify if you are being taken advantage of, the best thing to do is to sort through the facts and figures. Analyse if the provider is acting in good faith or simply attempting to minimise their payout.
In the upcoming chapters, we will compile a list of product features and review them carefully. Ultimately, our judgement can be summarised by the two words “Gimmick or not.”
Insurance companies advertise the abundant number of hospitals they’ve allied with.
Here’s an example:
One company’s website shows 5000+ network hospitals.
Another company boasts about 9000+ network hospitals.
This statistic shows that there are in excess of 9000 hospitals available to users.
You’ll witness this trend on many websites – network hospitals being the key feature.
If you’re new to this concept, chances are you’re wondering: why is there so much emphasis on this notion of a network hospital? What does it entail exactly?
It’s obvious network hospitals play a major role in our lives. Whether you’ve had a slight or serious injury, they can be an absolute lifesaver. Take for example, if you have an accident and are taken to a hospital located just two blocks away, this would come as a massive relief.
If your insurer has already collaborated with the hospital, this is what you may expect. The hospital will request your health card and write down the policy number. They can also try to verify your identity to be sure it’s really you. Upon completion, the hospital staff will inform the insurer that you are receiving care at their facility. They will provide data about hospitalisation, expenses and other relevant issues. Then, they’ll await a response.
The hospital may request an additional Rs 10,000 from you as a precaution. This is to prevent any complications should the insurer not consent to cover the bill. It’s a measure of protection for both themselves and you, so that you don’t have to worry about footing the bill if things don’t work out. Upon receiving approval from the insurer, the deposit will be refunded immediately.
Meanwhile, the insurance company will assess the validity of your claim for up to two hours. They must ensure you’re not currently receiving care for a condition not included in their coverage plan. Once everything is confirmed, they’ll pre-approve a sum – a maximum of Rs. 2 lakhs. This first step confirms to the hospital that they will pay up to the said amount once you’ve been discharged.
The underlying point of this narrative is that if you are in a hospital within the network of your insurer, they will cover the costs without requiring any payment on your part. This is often referred to as a ‘cashless claim’, which can be extremely helpful for anyone with money concerns.
Conversely, if you’re not affiliated with a network hospital, it may be quite the undertaking to get compensated for your medical bills. You must gather all pertinent documents and have the hospital sign off on the claim form.
Once everything is organised, send them to the insurer, who will likely pose further questions. On top of that, they may request additional records from you. After all this, there might be a reimbursement of your expenses.
Network hospitals are often the focus of conversations between customers and insurers because of their ability to provide a respite from hefty bills. Such talk can be exhausting, but it is necessary.
You ought to be aware that insurers are not necessarily required to pay out a claim without actual cash when you’re at a network hospital. In fact, they retain the right to become cautious in such cases; for instance, if they believe your situation requires expensive treatment, then they may refrain from making any prepayment.
Many insurers will state they don’t have enough information at the moment, so they cannot process the claim. To get a more comprehensive investigation, they will need to access your medical records. After you are discharged, they may consider your application, however, it would be on a reimbursement basis.
Sometimes, the pre-authorization is minimal at best. For instance, one customer had a bill that amounted to Rs. 2 lakhs. However, their insurer only allowed for Rs 50,000 initially. Despite this setback, the individual eventually recovered the remaining 1.5 lakhs. Initially, the customer was sad when he got to know that the whole amount couldn’t be pre-authorized.
In such a scenario, it is vital to contact your insurer and ask for a clear reason why they won’t settle the claim on a cashless basis. If only a small amount has been pre-authorized, find out their reasoning; if it appears doubtful, consult the Ombudsman, which may prompt them to reevaluate. Ombudsman is an official appointed to investigate individuals’ complaints against a company or organisation, especially a public authority.
Be sure to get a comprehensive policy and don’t forget that having a wide coverage doesn’t guarantee the most cost-effective options. Consider your insurer’s availability; they could have 10,000 networks across India but only ten hospitals in your area. Take into account the location of these facilities then make the purchase that best suits your needs.
Verdict- Not a gimmick