Insurance Claim Journey

My dear friends,

Greetings to you all.

 As you know, I share my experiences through blogposts, so that they will be useful to others.

Through my below-shown blog post link, the details of my  Prostate surgery on 6.9.2023 at the AINU, Chennai were shared. 

https://helpinghandsnaseer.blogspot.com/2023/09/treatment-at-ainu.html

I would like to share my experiences related to the Insurance claim settlement, with you all.

At the outset, I wish to extend my heartfelt gratitude to the Insurance Company team for their swift and efficient handling of our insurance claim. Their prompt response and the timely crediting of the sanctioned amount to our bank account provided us with much-needed financial support during a challenging time.

Life is full of unexpected twists and turns, and it's a comforting thought to have insurance coverage when those twists bring us face to face with unforeseen challenges. One such challenge for me and my family was a recent medical incident that led us to make a claim on our insurance policy. While the insurance company played a vital role in providing us with financial support, the journey through the claims process was not without its share of questions and concerns.

Claim Amount vs. Sanctioned Amount

Our insurance claim was for a substantial sum of Rs. 1,92,534. However, when the dust settled, we found ourselves with a sanctioned amount of Rs. 1,30,841. While we fully understand that insurance claims often entail certain deductions, a discrepancy of Rs. 61,693 raised our eyebrows and led us to seek a deeper understanding of the deductions.

The Request for Reconsideration

In our email dated 28.9.2023, we initiated a request for reconsideration of the deductions made in the claim settlement. The focus of our inquiry was primarily on the deductions related to the Medical Needs of the hospital, medical records, and "Copay Deduction" and we sought clarity on the basis for this deduction.

The Copay Mystery

In response, we received an explanation that the "Copay" was calculated as 20% of Rs. 148,765, amounting to Rs. 29,753, with an additional flat copay of Rs. 3,000, resulting in a total deduction of Rs. 32,753. However, the story took an unexpected twist in their email dated 4.10.2023 when the "Copay Deduction" was increased to Rs. 36,460. The addition of Rs. 3,707 to the deduction left us perplexed, as we continued to seek clarity.

A Plea for Reconsideration

Subsequently, in our email dated 5.10.2023, we once again requested reconsideration of these deductions, emphasizing our desire for a positive response. Unfortunately, the response remained elusive.

Understanding the Other Deductions: The following were our concerns

1. Higher Room Rent Charges (Rs. 21,799): We fully comprehend and accept this deduction, which was related to our choice of higher room rent charges for our comfort.
2. Medical Records (Rs. 500): We paid Rs. 500 in response to the Hospital's request, a mandatory requirement for the submission of medical records as per their checklist. The hospital should have given these records free of cost. But they provided it against the official cash receipt, we paid the amount and added in the claimed amount.
3. Medical Needs of the Hospital (Rs. 2,934): This expense of Rs. 2,934 was incurred on medical necessities required by the Hospital for our treatment. We believe these expenses were integral to our care, Without these, the Hospital might not have performed the surgery process.
4. The Copay Amount (Rs. 32,753/36,460): Acknowledging the discrepancy in the copay amount, we have persistently sought reconsideration of this deduction, emphasizing the need for clarity.

Conclusion

The insurance claim journey has been a roller-coaster ride, where understanding the twists and turns has proven to be quite challenging. We embarked on this journey with the expectation that our insurance policy would provide a safety net during challenging times, but along the way, we discovered the need for clear and transparent communication during the claims settlement process.

As we await a resolution to our concerns, our experience has inspired us to share our story in this blog post. We believe that by sharing our journey, we can shed light on the complexities of the insurance claims process and encourage improved communication and transparency between insurers and policyholders.

Though our Insurance claim was settled and the amount was credited to our Bank account, yet, We look forward to the day when our concerns are addressed and our insurance claim journey reaches a satisfactory conclusion. 

Please stay tuned for updates on our quest for a fair and transparent claims settlement, as we will share the link to this blog post with our friends, the Insurance Company, and anyone interested in our journey.

Sincerely,

Abdul Naseer.