Mr Pradeep Yadav (our client) was hospitalized, a few months back. We were very confident that his cashless claim settlement would be smooth. However, due to a remark by the radiologist Mr. Yadav’s claim for cashless was rejected. The insurance company had raised a few queries based on the radiologist’s remark and as the hospital TPA staff could not answer satisfactorily, it led to the rejection of cashless facility.
We guided Mr. Yadav on how to answer the query point-to-point along with the necessary supporting documents. Following our instructions to the tee, Mr. Yadav was able to get his claim accepted and the payments were released promptly.
It is very important to keep an eye on the queries raised during a health insurance claim settlement. Most hospital TPA staff is untrained in these matters and claims can get rejected merely because queries are not answered properly/resolved on a timely basis. To avoid such a scenario, ensure your health insurance advisor is actively involved in the process of answering claims.
(Mr. Yadav’s consent has been taken, before publishing this case study.)
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