Ranjan Desai is always on time when it comes to paying the premium for his floater mediclaim policy. However,sometimes ago, when his wife underwent a surgery and he made a claim of `35,000, it was rejected. Desai was justifiably shocked.
“They denied it, saying we had not submitted the claim within five days of the date of discharge,” says Desai. He had approached the third-party administrator (TPA) 15 days after the discharge, but was asked to submit the claim after including the post-hospitalisation expenses. “I did so after 40 days of discharge as my wife could not travel and I was out of town on work,” says Desai, who has written to the insurer citing the reason, but is yet to hear from it.
What the TPA had failed to tell Desai was that between the time he first approached him and submitted the claim, the insurance companies had decided to tighten the deadlines. Recently, the claim submission period, which usually stretched from 30-60 days, got shrunk to 7-15 days for most companies. Interestingly, the stipulation has always been a part of the policy guidelines, but was not adhered to strictly.
The advancing of deadlines is being attributed to two reasons. One, the health insurers claim they are running into losses, which has prompted a close look at the claim submissions. Two, they are keen on reducing the incidence of fraud.
Whatever the reason for the advancement of deadlines, it is important that you adhere to these. At the time of hospitalisation, check with the insurer or TPA about the new time frame because there could be a difference in the timeline mentioned on the insurers’ websites and that on the checklist provided by the TPA
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source: Times of India
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