How to avoid mediclaim rejection?

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Transcription of the above video: How to avoid medical rejection?
Hello, Shailesh from Insurance Samadhan.

You must be aware that InsuranceSamadhan handles all the insurance-related issues like mis-selling, fraud, claim settlement, claim rejection, etc. You can find more about us on your website. The purpose of today’s video was to let you know that the cases that we receive are mostly related to when a patient is admitted to the hospital, at that time, the initial information that is being shared by the doctors forms the basis of inference or decision by the Insurance Company, whether the disease had a history prior to your buying the policy.

Let us understand how this situation works and how we can avoid this situation!

Suppose, a heart patient faces a cardiac attack and is being taken to the casualty or emergency. The patient might be in his senses or might not be in his senses. If he is unconscious, then his attendee would take him to the hospital. Once you reach the Emergency of the Hospital, the doctor prepares a sheet, called the Assessment Sheet. Some of the details like – Since when the patient is suffering from this illness, how many years it has been, and what kind of illness the patient is suffering from, are asked by doctors to prepare the Assessment sheet. A lot depends on the person who is mentioning these details about the patient to the doctor, be it the patient himself or the attendee.

For example- Suppose the doctor asks the question – “Since how many years are you facing heart pain”? And the patient responds by answering – “Since 5 years”. If the policy age is 3 years, then this will result in the Insurance Company presuming that the patient did not declare all his ailments and diseases properly at the time of buying insurance. There lies a big difference between having cardiac problems and having heart pain. Generally, patients tend to exaggerate their situation while disclosing it to the doctor. The doctor will mention 5 years in the Assessment sheet and it will make the case weak already which might lead to the customer not getting the claim.

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Now, how should you avoid such a situation?

Always give accurate and true information. Do not use such words which make your disease look like it has been existing for a longer time. If you will give true information, you will never face such a problem and your claim would be definitely given to you. Secondly, while going through your Assessment sheet, if you feel there has been some wrong information written in the sheet, you can immediately correct it right away because doctors and attendees can be in a rush while filling the sheet and there can be a scope of errors. I receive many such cases where such entries are made that the disease has been pre-existing and old but later the doctor clarifies and issues the certificate that wrong information was being provided to us and the patient did not have this disease in the past. So, if you are aware and careful in such situations, you can avoid unnecessarily rejecting the claim. Hope now you know how to avoid mediclaim rejection? Please do let us me know in comments if you have any questions

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