Insurance is easy to buy but tough to claim, if you are an individual. Raj Pradhan narrates a real-life story that takes you through the labyrinth of insurance company, broker, TPA and hospital to explain how to make a valid claim and how to avoid going out of pocket
The point about insurance, in fact the very purpose of buying it, is defeated, if your claim is rejected. Only those who have been through the hard-knocks of getting a claim paid, know how complicated it is for those who do not have corporate support. The best way to understand the complexities and pitfalls is to take the reader through a real-life example of what can happen, even in the best case scenario. And, indeed, this case is probably as good as it gets. It pertains to an office assistant at Moneylife, Rajesh Juwale.*Our first learning was that some good, cost-effective hospitals do not want the hassle of dealing with TPAs (third party administrators) or delays in payment by insurance companies.
* Our second lesson was that brokers are also not very savvy about the rules and you need to know them yourself.
* A third learning was that even if you have a cashless facility, the cost of registration as well as initial consultation and tests have to be borne by the patient.
* Our fourth learning was about finding out the cost of procedures and tests.
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