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The Ultimate Guide to Health Insurance: Avoiding the Traps Dr. Vikas Singh Warns About



Getting a health insurance (Mediclaim) policy is one of the most important financial decisions you can make. It should simplify treatment, allowing you to focus on recovery. However, as Dr. Vikas Singh, MCh (Urology), points out, many policyholders find themselves in a bind when the claim is denied due to hidden causes and simple mistakes. This guide breaks down Dr. Singh's essential, practical advice to ensure your policy works when you need it most.

 Foundation First: Policy Selection and Coverage (Why You Get Caught)


In This Image Dr. Vikas Singh Explains "Understanding Your Insurance Policy: Key Terms and What They Mean for You."
"Understanding Your Insurance Policy: Key Terms and What They Mean for You."

The first step to a secure policy is making the right decisions about coverage and necessity.


Ayushman Card & Private Policy: Which One Is Better?


The government's Ayushman Bharat Yojana provides excellent coverage up to ₹5 Lakh. However, Dr. Singh strongly advises that if you can afford it, you must also purchase a private health insurance policy. The reason is simple: you may need treatment from a specific doctor or at a hospital that does not accept the Ayushman Card. On that crucial day, a private policy ensures you still receive cashless treatment without dipping into your savings.


How Much Coverage is Enough? A City-Wise Breakdown


The appropriate coverage amount depends heavily on where you live. Medical costs vary drastically:

  • For smaller cities: A ₹5 Lakh policy is generally sufficient for a small family.

  • For Tier 1 or Tier 2 cities (Metros): Due to the high cost of advanced healthcare, you should aim for at least ₹10 Lakh in coverage.

  • While more coverage is generally better, choose an amount you can realistically afford to pay the premium for; avoid overly exorbitant policies (e.g., 4-5 crores) that make premium payments difficult.

Hidden Causes: Crucial Policy Features Your Agent May Skip


In This Image Dr. Vikas Singh Explains "Ensure your coverage keeps pace with medical innovation by choosing a policy that includes advanced and robotic treatments."
"Ensure your coverage keeps pace with medical innovation by choosing a policy that includes advanced and robotic treatments."

These are the vital, often overlooked details that determine whether your claim is approved or rejected.


 The Room Rent Trap: Why "No Capping" is Non-Negotiable


One of the biggest reasons for co-pay and claim deductions is Room Rent Capping. If your policy only allows for a general ward and you opt for a private room, the insurance company may proportionally reduce all associated costs (doctor fees, nursing charges). Always ask your agent for a policy with "No Cap for Any Room." This feature, while slightly increasing your premium, allows you to choose any available room (semi-private or private) without worrying about claim penalties.


Pre-Existing Diseases (PEDs): The Cost of Hiding the Truth


This is a non-negotiable rule: DO NOT hide any chronic illnesses (Pre-Existing Diseases) like diabetes or hypertension to lower your premium. The agent might encourage this, but if you have a claim related to a concealed condition, the insurance company can, and often will, reject your entire claim, arguing that you provided false information about your health. Be completely honest to secure your policy's validity.


Ensuring Coverage for Modern Medicine: Laser, Robotic, and Day Care


Make sure your policy is up-to-date and covers: Advanced Treatments: Procedures like Laser Treatment (e.g., for kidney stones) and Robotic Surgery are standard today. If your policy only covers basic surgery, they might deny the claim for modern treatments, forcing you to choose outdated options.

  • Day Care Procedures: Many minor surgeries and treatments are now completed in a few hours. Ensure your policy covers Day Care so that these quick procedures are processed quickly and cashlessly.

 Making the Claim: Protecting Your Money and Rights


In This Image Dr. Vikas Singh Explains  "Filing an Insurance Claim: The First Step Toward Getting the Support You Need."
 "Filing an Insurance Claim: The First Step Toward Getting the Support You Need."

Even with the perfect policy, errors in the claim process can cost you money.


Maximizing Your Claim: Don't Forget Pre- and Post-Hospitalization Costs


any people focus only on the hospital bill and forget that the policy covers expenses before and after the surgery or treatment. This includes:

  • Diagnostic tests.

  • Medicines purchased before/after admission.

  • Follow-up doctor consultations.

Keep all these bills and ensure they are submitted to get full compensation for the entire treatment episode.


The Reimbursement Process: What to Do When Cashless Fails


If your chosen hospital does not offer a cashless facility, do not assume your policy is useless! Pay the bill yourself, collect all necessary medical files, documents, and bills, and work with your agent to file a reimbursement claim. The claim amount will be transferred directly to your bank account.


Grievance Redressal: When to Contact IRDA


If the insurance company makes arbitrary deductions to your claim, or unfairly rejects it, you have recourse. The Insurance Regulatory and Development Authority (IRDA) is a government body established to protect policyholders. If you feel wronged, file a complaint with the IRDA for resolution. They help those who contact them to resolve disputes.

About Author-


Dr. Vikas Singh

MBBS, MS, MCh

Urologist, Uro-oncologist and Kidney Transplant Surgeon.

Senior Consultant, Kokilaben Dhirubhai Ambani Hospital Indore, Madhya Pradesh.


 
 
 

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