We all want to live a Healthy life without any major diseases, illness....with present awareness, we do take care of our Health with proper Exercise, Healthy Diet as well as consulting our Doctor.....However we may still face situation, in which we end up in Hospital ( for reasons beyond our control ) & for such situation we prepare our-self by buying Adequate HEALTH Insurance....Hoping that Insurance will help us during time when we need !! But that's not the reality
This is what exactly happened to us & sharing our story which can help many others to be well prepared & well educated & knowledgeable
I am holding a Family floater Health insurance from a reputed company for last 15+ yrs( claims Largest Standalone Health Insurance with large presence in South India ).
Recently my wife was hospitalized & since she had Employer insurance ( with limited benefits ), we used it as first preference for cashless settlement. This insurance paid 65% of bill amount which was as per Terms & conditions
After discharge, i raised claim with my personal insurance for balance 35% ( which fulfills my insurance policy criteria ) & submitted all documents, bills, reports needed for processing
To my utter surprise, my insurance company informed me that only 20% of the claimed amount qualifies as they used WRONG ACCOUNTING practices as well as did their own calculations which were WRONG . Since this was utter Nonsense & not acceptable, i raised Grievance with company Insurance Grievance officer & unfortunately they also didn't responded properly & increased a little bit amount
This is was totally frustrating since there is no one to call ( all call goes to untrained Call centres, No support from any Grievance Person ).....very much disappointing after being a customer for 15 year & first claim !!
SInce i was aware of Bima Lokpal, I raised Online grievance ( which is very Easy process ! )
I had documented each & every record ( Right from admission to Hospital till emails i sent to Insurance company ), Drafted a detailed day wise sequence of events.Within couple of weeks Bima Lokpal sent notice to Insurance company & Insurance company started contacting me for details....they took all details from me & concluded my claim is correct & agreed to pay me claim amount i raised !!!
This leads to key Learnings & lessons i would like to share
First....be Prepared to face a situation that you may not get your Due claim even if you have High Insurance coverage as companies will find all ways to see how they can Deny / Differ your claim ( All may not do but many will practise this )
1. Know your Policy basic Terms & conditions well in advance....what is Room rent coverage, waiting periods, Pre existing disease waiting, inclusion & exclusion of charges etc.....study well before buying policy as well as even if you are holding policy long time without any claim
2. Do check your hospital bill details as well as check if insurance company has rejected any specific cost for in correct reason
3. Keep your Documentation PERFECT...store all soft copy / hard copy of each & every consultation report, bills, lab reports etc by Date wise those will be very useful in future
4 If not satisfied with the settlement, write to Insurance company Grievance, 50% chances they may help for better resolution.
5. If still not satisfied, go to BimaLokpal....entire process of raising claim till Settlement is ONLINE, you don't need to step out of home !! Works efficiently
6. Never Give up....in the present online era, writing a Well drafted email to a concerned person ( and sometimes with a couple of follow ups ), you will get help & resolution.
7. If your case is Genuine , don't give up....take help from some one in family / friends / financial advisor if you are not well conversant with online / emails, but getting our Dues is our Right as customer & we should Exercise it time to time
Also Bima Lokpal can be contacted for All kind of insurance complaints ( Health, Motor,Life ) , you can find more information about them online.
Useful link : To raise complaint use any following link
https://cioins.co.in/Complaint
https://bimabharosa.irdai.gov.in/RegComplaint/RegisterComplaint
Regards
Sunil ( An Ordinary Common Man, who fights for due Rights ! )
This is what exactly happened to us & sharing our story which can help many others to be well prepared & well educated & knowledgeable
I am holding a Family floater Health insurance from a reputed company for last 15+ yrs( claims Largest Standalone Health Insurance with large presence in South India ).
Recently my wife was hospitalized & since she had Employer insurance ( with limited benefits ), we used it as first preference for cashless settlement. This insurance paid 65% of bill amount which was as per Terms & conditions
After discharge, i raised claim with my personal insurance for balance 35% ( which fulfills my insurance policy criteria ) & submitted all documents, bills, reports needed for processing
To my utter surprise, my insurance company informed me that only 20% of the claimed amount qualifies as they used WRONG ACCOUNTING practices as well as did their own calculations which were WRONG . Since this was utter Nonsense & not acceptable, i raised Grievance with company Insurance Grievance officer & unfortunately they also didn't responded properly & increased a little bit amount
This is was totally frustrating since there is no one to call ( all call goes to untrained Call centres, No support from any Grievance Person ).....very much disappointing after being a customer for 15 year & first claim !!
SInce i was aware of Bima Lokpal, I raised Online grievance ( which is very Easy process ! )
I had documented each & every record ( Right from admission to Hospital till emails i sent to Insurance company ), Drafted a detailed day wise sequence of events.Within couple of weeks Bima Lokpal sent notice to Insurance company & Insurance company started contacting me for details....they took all details from me & concluded my claim is correct & agreed to pay me claim amount i raised !!!
This leads to key Learnings & lessons i would like to share
First....be Prepared to face a situation that you may not get your Due claim even if you have High Insurance coverage as companies will find all ways to see how they can Deny / Differ your claim ( All may not do but many will practise this )
1. Know your Policy basic Terms & conditions well in advance....what is Room rent coverage, waiting periods, Pre existing disease waiting, inclusion & exclusion of charges etc.....study well before buying policy as well as even if you are holding policy long time without any claim
2. Do check your hospital bill details as well as check if insurance company has rejected any specific cost for in correct reason
3. Keep your Documentation PERFECT...store all soft copy / hard copy of each & every consultation report, bills, lab reports etc by Date wise those will be very useful in future
4 If not satisfied with the settlement, write to Insurance company Grievance, 50% chances they may help for better resolution.
5. If still not satisfied, go to BimaLokpal....entire process of raising claim till Settlement is ONLINE, you don't need to step out of home !! Works efficiently
6. Never Give up....in the present online era, writing a Well drafted email to a concerned person ( and sometimes with a couple of follow ups ), you will get help & resolution.
7. If your case is Genuine , don't give up....take help from some one in family / friends / financial advisor if you are not well conversant with online / emails, but getting our Dues is our Right as customer & we should Exercise it time to time
Also Bima Lokpal can be contacted for All kind of insurance complaints ( Health, Motor,Life ) , you can find more information about them online.
Useful link : To raise complaint use any following link
https://cioins.co.in/Complaint
https://bimabharosa.irdai.gov.in/RegComplaint/RegisterComplaint
Regards
Sunil ( An Ordinary Common Man, who fights for due Rights ! )
