What to do when health insurance policy claim is rejected

I am senior citizen. I was hospitalised for a urinary problem. When I claimed insurance, the TPA rejected it saying it is not covered under my policy. Can I speak to the insurance company for the reason why they rejected my policy? - R S Mehra

Claim admissibility is based on the terms, conditions, coverage and exclusions of the policy you have purchased. As some broad rule, health insurance policies typically do not cover a pre-existing medical condition, unless expressly mentioned. Even if these are covered their acceptance is post a waiting period as specified by the insurance company. 

Secondly, hospitalisation is typically required for a claim, unless the policy also covers day care procedures or is specifically for OPD expenses. If the claim is rejected, the insurance company typically gives a letter with details of the same.

However, you can always contact the customer care centre for better understanding of your coverage and policy terms and conditions to your satisfaction.

Is colonoscopy done at doctor's clinic reimbursed under Family Floater mediclaim policy? - Bhalchandra Kulkarni

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Colonoscopy is an advanced diagnostic procedure. Its admissibility generally depends on the respective policy terms and conditions. Generally, the admissibility is considered if the procedure is conducted under day care procedure in a hospital/day care centre.

By: Tapan Singhel

(The writer is , MD & CEO, Bajaj Allianz General Insurance)

Source: DNA Money

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