Simplifying Health Insurance Claims: The Policybazaar Show

Five years back, people used to buy health insurance to take care of ailments in old-age. They certainly didn't want to hurt their pocket during retirement. That was the fundamental need for health insurance. However, nowadays, Covid-19 has made health insurance more relevant than ever. This infectious disease can happen to anybody- a young as well as an old individual. Not just Covid-19, many diseases like cancer, heart problems are happening to a lot of young people as well. So, buying a health insurance policy comes in handy whenever the need for treatment arises. 

Claim is the moment of truth in health insurance and a customer wants a seamless experience during claim settlement. Historically, we have heard torrid stories about denial of claims to customers. However, digitization has transformed those tedious and time-consuming claim processes. 

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DIGITIZATION HAS MADE CLAIMS PROCESS EASIER 
Nowadays, claims processes have become very simple and streamlined due to digitization. All you need to do is just inform your insurance company in advance in case of planned surgery and in emergency cases, inform your insurer as soon as possible.  The biggest challenge faced by customers is that they don't know the claims processes and nobody handholds them at the time of claim.

They get a bit lost about what exactly needs to be done and where do they need to go at the time of hospitalization. Customers must know the complete process which is very simple. It takes a few minutes to get the preauthorization done from any large health insurance company and it probably takes an hour to get the final approval. Proper documentation at the time of filing a claim is necessary. 

HOW TO PREVENT CLAIM REJECTION
Customers should make sure to declare everything at the time of buying the policy to avoid claim rejection. When buying a policy, if a customer doesn’t disclose everything from a medical perspective that has happened in the past like a surgery or a pre-existing disease, then your claim will get rejected. The insurer asks whether you are taking any daily medication, past surgery, accident, major illness, consuming alcohol, smoking or tobacco intake.

Health insurance claims may also get rejected because of going beyond sum insured, ignoring the exclusions, suppression and misrepresentation of facts, exceeding the time limit or late intimation to the insurer, lapse of the policy etc.  

Customers should follow these to prevent rejection of claims:

• Read policy documents thoroughly.
• Be aware of exclusions, deductibles, and claims processes. 
• Disclose correct and complete health-related information.
• Provide all medical records to a third-party administrator. 
• Timely renewal of health insurance policy. 
• For planned hospitalization, look for the insurer’s approval in advance. 

POLICYBAZAAR’S CLAIMS ASSISTANCE 
If you already know that you are going to the hospital, just inform your insurance company or agent. In case you have bought the policy from Policybazaar, inform them. Policybazaar will coordinate with the insurance companies and make sure you have a seamless experience. Your hospital bed will be reserved by the time you reach the hospital. You can just go and get your treatment done and you will have the approval within a few minutes. Policybazaar coordinates with hospitals to extend a seamless experience for its customers. 

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IRDAI REFORMS MADE CLAIMS PROCESS FASTER 
The regulator has done a phenomenal job in making the claims process faster during Covid-19. The regulator directed faster processing and approval of Covid claims. Thereby, Covid-19 claims are being prioritized by insurance companies. Moreover, as soon as the pandemic stuck India, the regulator announced that all health insurance policies will cover Covid-19 treatment. This was a respite for the consumers. There are dedicated teams in insurance companies that work only on Covid-19 claims. There are also special committees composed of senior management in insurance companies that look at Covid-19 claims in case of rejection. The only reason for rejection of Covid-19 claim will be if it hasn’t served the waiting period. Most insurers have 15-30 days of the waiting period for Covid-19. 

KNOW THE ROOM RENT CAPPING 
In case of a cashless claim, no amount is being paid from your own pocket. The insurer takes care of the hospital bill. Processes now take much less time than before. Make sure you know the terms and conditions of your policy. For example, every health insurance policy has a room rent capping. Customers must be aware of the room rent capping. Most health insurance policies today say that you can go to a hospital up to a single private room. Now, the rates of single private rooms may vary. For example, some big hospitals will go upto Rs 20,000 whereas at a relatively low-cost hospital, you can get it upto Rs 5,000. Whichever, hospital you go to, make sure you opt for single private room as that is the category mentioned in your policy. The insurer will pay the expenses for the room if you opt for the category mentioned in your policy. In case, you opt for a room with a higher rent, over and above the room rent capping, you will have to bear extra expenses. 

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