FinTechGenie 🧞

🚨Health Insurance Company capped our ₹50,500 claim at ₹33,500 and asked us to pay the rest from our pocket. This despite us not having any sublimits on the procedure. Challenged the approval, and got the complete amount approved and the balance ₹17,000 refunded. This is what helped us - 1. Know your policy. Ensure that you have complete understanding of your policy including what's covered and what's not. 2. Do pay special attention to any Sublimits that may be applicable. 3. If only partial claim is approved, ask for the reason of rejection. It may be cryptic sometime so ask them to help you understand that in a normal human understandable language. 4. Always ask for detailed/itemized bill from hospital. 5. If you are convinced that your claim should be fully approved - then talk to your hospital and ask them to send for reconsideration. 6. Talk to your TPA contact (if any) and make them aware of the situation. If you are right, you may also have to challenge them (we also did). 7. If your policy is via corporate, email to your HR contact if above did not work out. 8. Be firm on your point but also be patient. @themahavir @NIKHILLJHA @AdityaD_Shah