After all, why 100 percent claim is not available in medical insurance, know what are the rules regarding this

Medical Insurance It is bought so that they get proper medical facilities in an emergency and do not have to pay a hefty bill for this. However, when medical insurance is claimed, the policyholder does not get 100% claim of the bill. He also has to deposit money from his pocket. In such a situation, the question arises in the mind that despite the remaining insurance limit, why do you have to pay out of pocket?

As we know, even if an individual has a cashless health cover, he has to deposit some part of the medical bill from his pocket. In a report published in Mint, Ankit Agarwal, co-founder of InsuranceDekho, said that the health plan covers various types of medical bills. However, there are some expenses which are not covered under the policy. Sometimes it happens that the insurance company sees some unnecessary tests in the medical bill. Such tests do not seem suitable for the disease, due to which the claim benefit is not available.

Complete information about coverage is given in the policy document

When one buys individual medical insurance, the details of expenses incurred for different needs are shared in the policy document. There is also a separate capping for each expenditure, which is its maximum limit. Apart from this, if any kind of expense is included in the medical bill, then the insurance companies refuse to pay the claim.

Non medical expenses are not included

Medical insurance does not cover non-medical expenses such as administrative charges, registration, surcharge, food consumed by the attendant other than the patient, all such bills.

Get the test done related to the disease for which you are admitted

If a patient is admitted to the hospital for X disease and during this time he also undergoes investigation related to any disease Y, then the insurance claim is not received. In such a situation, get the treatment of the disease you go to the hospital or get admitted for. If someone else gets the test done unnecessarily, then you will have to pay money from your pocket for this.

Room rent remains fixed for each policy

Room rent forms a major part of the medical bill. The room rent remains fixed for different policies. If a patient wants to shift from him to an expensive room, then he will have to pay money from his pocket for this. It is important to understand here that consultation charges, operation theater charges, room service charges are fixed on the basis of room rent. In such a situation, if you shift to a more expensive room, then every charge increases. In this case, the insurance company can reduce the claim significantly.

No claim benefit on consumables

Apart from this, many types of expenses are also incurred in the name of consumables. Insurance companies do not cover most of these expenses. This is the reason that some percent of the medical bill has to be deposited by the policyholder from his pocket. However, it cannot be denied that having medical insurance allows you to pay a certain percentage of the medical bill and get discharged. Insurance companies pay the outstanding bills. For this, you have to pay some rupees from your earnings every month to the insurance company as premium.

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