need help with medical insurance claim

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mymatl

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recently i have been blessed with baby girl :)

i have medical insurance in the company, but unfortunately the hospital where my wife had delivery is not in the insurance network list. Hence i had to pay the bill first and needed to claim later.

coming to my query, room rent was 3000/day
but in the final bill hospital has given us breakup of room rent as 1000rs towards room med & allied charges and rest 2000rs towards room nursing & dmo charges.
the problem here is, my insurance didnt approve these med & allied charges.

total for 6days, it is 6k :mad::banghead:

i wanted to know if this is as per rules?

please help
 
There's lots of fine print involved. This varies a lot across companies and policies. Read your policy documents carefully and request the hospital authorities to bill it accordingly, but these things are better done before discharge. Still explore if something can be done. Usually the hospital authorities oblige in most of the cases.

Anyways congratulations for the little angel in your life, my best wishes.
 
thanks for your replies guys

infact my room rent was within the limits which was 6k/day

while admitting in the hospital i was told that rent is 3k/day, so i agreed as it was within the policy limits
but in the final bill, they gave room rent with detailed breakup like for room 750, room dmo charges 750, room nursing charges 500 and room med & allied charges as 1000 per day
 
your policy will have all the details in the fine print. many charges such as room nursing, food for patient etc. are not payable as per policy. so these will have to be borne by you.
room rent is only what the hospital bills as room rent. best to stick to network hospitals as these things never get to be an issue then.


this is also one of the reason partly why such hospitals are not in cashless networks as insurance cos and tpa now want such things to be changed as well.
 
Usually policy pays for medicines and surgeries and associated expenses are to be borne by us like any other fees or charges. But again that depends on the policy and its terms and conditions.

Best bet is to opt for hospitals mentioned in the policy as they have tie ups and at times even most misc. expenses get covered in the policy itself.
 
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