How to Claim Medical Insurance

Here is my experience in claiming medical insurance when I was sick. My experience may be helpful to you to claim your medical insurance. I have been in Medical Insurance coverage for the last 5 year. Two times I was hopitalised. My kid hospitalised once.

Overall, my family hospitalised for three times in 5 years. I claimed medical insurance twice. My claim was rejected once.

First. My kid hospitalised due to diarrhea and fever for several days. Later doctor diagnosed it as viral fever. She was admitted for 5 days in Surya Hospital – Vadapalani, Chennai.

During admission we paid Rs.1000 and presented our medical insurance ID card. After 5 days, the hospital bill was Rs.15500. Insurance company sent Rs.15000 to Hospital. While discharging we paid just Rs.500. We also got back our Rs.1000, which we paid during admission.

In this case the process was so simple. We produced the medical insurance ID cards. They scanned the card front and back, faxed the scanned copy to our Insurance company.

Second. I was hospitalised for diarrhea in the same Surya Hospital. I was receiving continues trips. Now the medical insurance claiming process seems to be so complex. We produced the medical insurance ID cards to the hospital authorities. Our ID cards did not possess our Photo. They asked the Insurance certificate, and receipt of the latest/last premium paid. They also demanded the photo copies of all documents related medical insurance in advance. My wife shuttled here and there.

I was about to discharge, but there was no reply from the Medical Insurance company. I do not know how to claim the medical expenses after getting discharged from the Hospital. So I extended my stay in hospital for a day. Because, I feel it is easy to claim medical insurance when admitted in hospital.

Hospital authorities take care of the process, documents, procedures to claim. After post hospitalisation, we have to shuttle to Insurance company with the discharge summary and billing to claim money. I do not feel it would be so easy as claiming through hospital.

But this time, my claim for medical insurance was rejected. I was informed from the Insurance company that, my disease (diarrhea) does not require hospitalisation. It could be treated from home. Big bang to me. I cleared my hospital bill by credit card.

I felt I could have succumbed to diarrhea rather receiving firing from my wife. Because, I was about to be admitted in general ward, but I chosen single room with TV. Rent for single room is higher than general ward. I was confident that I could pay everything from medical insurance.

Oops, Things did not turn up.

Third. After couple of months, I was hospitalised again for a unknown fever. I had fever for more than 10 days. I was so weak. I took lots of expensive medical tests.

Soon doctor advised me to admit in the hospital. I was afraid of hospital bill. I did not go to job for the last 4 months. Anyway, I was admitted in hospital. Again Surya Hospital.

This time, I booked a single big room with AC and TV. I was staying in the hospital for four days. Almost three doctors diagnosed me. After fourth day, I decided to return to my home. No idea about what was the cause for fever. Viral fewer is the cause when nothing is diagnosed.

Like last time, we had hip-cups and shuttling for claiming medical insurance by hospital authorities. My wife wanted me to stay in the hospital for couple of days more to receive Medical insurance to pay the bills. I was stressed too much, I requested to discharge without waiting for insurance amount.

Meanwhile, hospital authorities said they have faxed things to Insurance Company, so we may get the claim anytime. Anyway, I paid the bill by credit card, back to home. My bill was around Rs.16000 and something.

For the next couple of days, my wife follow up the hospital. Later they informed me that, Insurance company sent the money. We could collect it from the hospital. We received Rs.12000 as Medical Insurance. Insurance company said, the maximum room charge allowed per day is Rs.1000 for me. They could not pay Rs.1500 per day.

Moreover, I did not claim pre-hospitalization expense like expensive medical test. I do not know how to claim those things from Insurance Company.

I am little hesitated to claim medical expense once I am discharged from hospital.

Medical Insurance Companies should make the process so easy to claim after discharged from hospital.

If you read between the lines, you can understand which is my instant medical coverage and emergency management.