health insurance claim

8 Questions on Health Insurance Claim and Their Answers

health insurance claim

We came across a few queries on  MediBuddy’s insurance claims portal that troubled users. Well, insurance and claims can be tricky…there can be a million problems — well, maybe even more. But in this post, we’ve identified 8 queries — and their answers — which can help make your journey easy-breezy on MediBuddy.

Query #1: Why is it important to submit a cheque leaf?

You will be required to submit a cancelled cheque leaf during a health insurance claim process as it acts as a proof of the individual holding the account. Moreover, it aids in the electronic transfer of funds by eliminating any typographical errors and/or false information about your bank details.

Query #2: Where do I see the policyholder and dependant(s) details in the portal?

You can view your insurance policy details, coverage, terms and conditions, and dependant information by clicking on ‘Policy Detail’ after signing into MediBuddy.  It’s important to note that dependants can be only be removed/added while your policy’s enrolment window is open.

Query #3: Where do I find policy terms and coverage details on MediBuddy portal?

Log into MediBuddy and navigate to ‘Policy Detail  where you’ll be able to see:

  • Policy Terms and Conditions
  • Policy Coverage
  • Dependant(s) information
  • Family Sum Insured
  • Balance Sum Insured
  • Insurer Name
  • Policy Name

 

Query #4: Why is it necessary to send the physical copies during insurance claim submission despite uploading the soft copies?

Physical copies are required during an insurance claim submission for the following reasons:

  • A direct mandate from insurers (not all) demanding all original medical records. Please check your policy terms and conditions to know more.
  • To prevent any discrepancies, fraudulent activity, and overinflation of claim amount. Moreover, these documents help in the auditing of the TPAs and the Insurers.

Providing up-to-date information and the originals is one way to ensure that your claim isn’t rejected or denied. Complete disclosure and submission of original documents add authenticity to your claim. Here are the documents you’ll have to submit while submitting a cashless or a reimbursement claim.

Query #5: Why is there a delay in approval of claims?

There can be a variety of reasons why your claim might be delayed: treatment/ailment not covered under your policy, invalid/expired policy, inaccurate information, and more. Here’s a post that talks more about the delay in claims in detail.   

Query #6: Who do I contact if I have a problem in uploading the documents/govt id proof?

Uploading documents on MediBuddy shouldn’t be a hiccup. However, in the unfortunate event of a failed document upload/submission, you can:

  • Call the Claims Helpline on the Contact Page or drop a query under ‘Your Queries’ on the after logging into MediBuddy

 

Query #7: Why is it required to fill in Date of Admission and Date of Discharge for domiciliary claims?

You won’t have to fill in the date of admission and discharge to raise a domiciliary claim but have to mention the duration of treatment,  including the documents listed below.

  • Claim form
  • Doctor’s prescription which must contain the line of treatment, nature of the ailment, medicines dispensed or prescribed for treatment, and the duration of treatment. The prescription must not contain payment details.
  • Pre-numbered doctor’s original bill from doctor’s official bill book
  • Original cash memos/chemist bills for medicines purchased
  • Copies of all lab test reports and other test reports ( if applicable )

Domiciliary treatment covers all ailments (subject to policy terms and conditions) that do not require hospitalization which also includes treatment taken at the OPD in a hospital or a physician.

Query #8: Which types of claims are usually denied/rejected?

The waiting period and the terms and conditions of your insurance policy are a couple of reasons behind a claim rejection. Here’s an article that lists all the reasons that open the door for claim rejections, cashless or reimbursement.

Help is at hand, with MediBuddy!
Let MediBuddy help you plan better. View the details of your policy, including exclusions and other conditions, online; use the Network Hospital search feature to locate, compare and choose an ideal hospital for cashless treatment; and use the Online Claim Submission feature to not only enjoy hassle-free claim submission but also reduce instances of deficient documentation.

copay insurance

Does Your Policy Have a Copay Insurance Clause? Find Out What It Means

copay insurance

Medical expenses are always on the rise. So, people are on the hunt for good insurance policies. After all, no one wants to foot a huge bill. However, high premiums can deter people from buying good policies. This is where you can take advantage of the copay insurance to enjoy better coverage at low rates.

This article explores copay insurance and what you can expect from it.

What is copay insurance?

Copay insurance is a type of healthcare plan with a clause stating that the insured party must pay a part of the bill. The amount you must pay is fixed. For instance, you may need to pay 10% of the total bill. In this case, if your hospital bill is 30,000, you must pay Rs 3,000 from your pocket. Of course, at this point, this may not seem like a huge problem. But remember, treatments for major conditions flow into lakhs. Thus, having to pay 10% can burn a hole in your pocket. Therefore, you should evaluate a policy carefully before buying it.

Why do health insurance companies offer copay insurance?

Copay insurance is not exactly a favourite amongst health insurance seekers. So, people often wonder why companies even offer these. The following are a few reasons why a policy may contain a medical insurance deductible:

  • With copay, people are liable to foot a certain amount of the bill. Companies add a co payment clause to discourage them from making unnecessary claims. Many patients make claims for generic gastric problems or small ailments. This means that companies must bury their heads in a lot of paperwork. The co-payment clause helps them avoid this.
  • Adding copay in medical billing ensures that patients do not go to more expensive hospitals. Polls in India show that boutique hospitals, high-end clinics, and speciality centres often charge 40% more than regular hospitals do. It encourages patients to go to more affordable hospitals offering high-quality treatment.
  • Finally, copay also decreases the risk and overall liability that an insurance company must incur. They save a minimum of 10% of the total hospital bill. This is because the insured party must pay that themselves. 

So, why would a consumer even consider buying copay insurance?

The biggest drawbacks of leading healthcare plans are often the high premiums that come with them. Most consumers understand that these high premiums can translate to a wider coverage when it comes to illnesses. However, not everyone can afford these insurance policies. Does that mean that the average consumer should buy a sub-par insurance policy and keep his/her fingers crossed? Of course not!

Policies come with a co-payment clause to make the insurance premiums more affordable. With the risk and liability to the company reduced, insurance providers do not fret over offering premium services at lower rates. Some healthcare providers charge as high as 20% as the medical insurance deductible.

Of course, for consumers, the flipside is footing a portion of the bill on their own. But, on the other hand, it does provide them with better policies at cheaper rates.

What to consider before buying an insurance policy?

You’re probably wondering whether to buy copay insurance or regular healthcare plans. You must first jot down your priorities. This can help you pick a plan that suits your needs. Consider the following:

  • Are you taking steps to save money?
  • Do you have any other financial investments planned?
  • Does your family suffer from hereditary diseases?
  • Do your lifestyle choices put you at risk for certain diseases? If you are unsure about it then you can consult a doctor on MediBuddy to find out.
  • Are you earning enough to account for sudden medical expenses?

These factors can help you decide what type of insurance to buy. If you have taken steps to set aside funds for emergencies, and do not want to pay high premiums, then copay insurance may be the right fit for you. Conversely, if you cannot account for sudden medical expenses, perhaps regular healthcare plans may benefit you more.

Copay insurance is not a bad thing. These healthcare plans can allow individuals to benefit from better coverage without paying high premiums. The higher your copay amount, the lower your premium will be. Therefore, you should look at your copay amount carefully before committing. Of course, do take into consideration inflation and typical medical expenses before making your final choice.

Healthcare plans are vital. It is better to have copay insurance than no insurance at all. So, get copay insurance. And always safeguard your health with MediBuddy. 

 

wellness calendar

Wellness Calendar by MediBuddy: Chart Your Health Goals for 2019

 

wellness calendar

Another year, another chance to do something good for your health. But will you?

If you’re like half of the adults on this planet, you’ll have a New Year’s resolution. But once the fireworks stop, the greetings have done their rounds, and your favourite bottle of bubbly goes back on the shelf, the same pledge is hard to fulfil. The thing about a resolution is that the fire that ignites it ebbs away into obscurity with each passing day. According to reasearch, only about 77% of resolutions are on track just a week into the New Year. And in about six months, only about 40% will have stayed the course.

Now, there might be countless reasons as to why a pledge fails. Two of the culprits include having unrealistic goals, and having troubles transforming your dreams into actions and then sticking to them. You must know how to outsmart the odds by breaking down your pledge into doable goals and making sure that you follow through every day.

How Can The MediBuddy Wellness Calendar Help?

In the same manner you break down your pledge into doable goals, you should break down the timeline you’ve set to fulfil the pledge. Sure you can use any calendar to track your progress, but this calendar gives you so much more. Within the calendar you will find information about 12 World Health Organization days that commemorate public health issues: World Leprosy Eradication Day, World Cancer Day and the like. Moreover, every month carries an interesting fact, figure, or a health tip that revolves around the WHO day.

As an individual with a pledge to improve your health (which already qualifies you as an ambassador of good health), you should also be aware of global health issues so that you can inspire others to do more.

We’ve got the ball rolling, now it’s your turn to keep it going. Download the
MediBuddy e-Calendar and keep track of your health all year long. Wish y-
ou a bright and healthy New Year! Stay well!

online medicine

Order Up! MediBuddy’s Online Medicine Service To Prevail

online medicine

And so it was decreed by the Delhi High Court — online medicine sales to cease until the central government frames rules and regulations. The online pharmacy fraternity was thrown in a tizzy when the gavel was pounded, and the word spread like wildfire on the internet.

What does the ‘Rule’ entail?

According to the new draft rules, e-pharmacies must register with the Government of India and their operations will be strictly regulated by the health ministry. The new directive also goes on to say that online pharmacies must register under CDSCO (Central Drugs Standard Control Organisation) and land an all-India trade licence from any state government.

But it doesn’t end there. Medicines being purchased online will also require prescription(s) and pharmacies disbursing the goods must chronicle records. Also, patient confidentiality must be respected and no information must leak, domestically or globally.

The verdict also mandates setting-up of facilities for grievance redressal and customer support, with a complete embargo on the sale of tranquillizers, psychotropic drugs, and narcotics.

How Will This Change Benefit The Consumers?

Lawmakers insinuate that online pharmacies are unregulated in the present regime. When you deal with unauthorised pharmacies, you run the risk of using spurious, contaminated, sub-standard, misbranded, and fake medicines which can put your safety and health in grave danger. So, this ban on online medicines clamps down on such practices.

The verdict also touches on the subject of prescriptions. The practice of selling medicines without a valid prescription can have fatal consequences as people can misuse drugs that can lead them to drug addiction. This ban, in effect, fosters patient safety and safeguards citizens from situations like a drug epidemic or drug abuse.    

The ruling from the courts is in the interest of the consumers at large, to protect their rights and their health from malicious practices. With the rise in e-commerce and changing trends in lifestyles and consumer behaviour, availability of medicines online instantly started to find favour with urbanites in particular. It also came as a boon for areas with limited access to pharmacies and for repeat orders for chronic ailments.

The Big Q: Will MediBuddy’s Online Medicine Services Continue?

While how many courts follow suit and what other rules will be implemented is still up in the air, you can, as always, order medicines on MediBuddy. Truth be told, we’ve always adhered to rules and made our services available for consumers by operating within a framework stipulated by the higher-ups.

Here’s why we were, are, and will continue being your trusted online medicine provider.

  • We partner with only licensed service providers for delivery of prescription medicines, right to your home or office
  • A valid prescription is all you require for doorstep delivery/in-store pickup of medicines by licensed service providers on MediBuddy

Genuine medicines. Licensed partners. Doorstep delivery or in-store pickup.
Multiple payment options. And that’s not all, you can even make your purch-
ase cashless on MediBuddy if your insurance policy provides cover.