I will be sharing some true incidents and look at what we can learn from them.
A) A particular gentleman was admitted in the hospital for a minor surgery. After surgery the very next day, in a hurry to get discharged he settled the bill ASAP. When he applied for reimbursement, the claim was denied on the reason that the hospitalization was not for a period of 24 hours. The final bill that was generated had a time stamp on it which showed period of hospitalization for 22 hours.
Takeaway – All claims require a minimum of 24 hours hospitalization, except day care procedures. Day care procedures do not require 24 hours hospitalization and can be claimed with pre-authorization.
B) We had given a presentation on a particular health policy to a family. He agreed to take it, but due to his busy schedule he kept delaying. Finally, 3 months later he took the policy for his family. Within 15 days (from the start of policy) he was admitted for Covid-19. His claim could not be admitted, as only accident related claims are admissible in the first 30 days.
Takeaway – Once you decide to take a policy, DO NOT DELAY.
Augustine Mendez
Chief Service Officer, Freedom Factory.
NISM-Series- V-A certified MFD,
IRDA certified Life and Health Insurance advisor
www.freedomfactory.in
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