HIDDEN Reason Behind PARTIAL Claim Settlements! | Understanding Reasonable & Customary Clause
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- เผยแพร่เมื่อ 29 ก.ย. 2024
- In this eye-opening video, Shrehith and Sushant dive into the ‘Reasonable and Customary’ clause found in every health insurance policy. Discover how this clause can impact your claim experience and learn how to protect yourself from exorbitant hospital bills.
To know more or find the best term insurance plan for yourself, talk to our advisors at Ditto Insurance: ditto.sh/273uwz
Takeaways:
- The ins and outs of the 'Reasonable and Customary' clause and how it works.
- Practical tips on how to safeguard yourself against unexpected hospital charges.
- Real-life examples illustrating how insurers handle overcharged medical bills.
- What an Ombudsman would suggest when faced with such situations.
Don’t miss out on these essential insights that could save you a fortune on your healthcare costs. Watch the full video to uncover the truth and arm yourself with knowledge!
Koi Marne Ki Haalat Main Raha Toh Negotiate karna Jaruri Hai Kya? Aur negotiate karte karte agar mar gaya to fault kiska hai?
Insightful ❤
Thank you so much :)
How I can make ditto as my advisor
Just book a FREE call here: ditto.sh/273uwz
The fact that insurer have enlisted certain hospitals on their panels should be proof that insurer is aware of charges levied for different procedures and that their is agreement on the charges levied. If insurers think hospitals charges premiumly why in first place they have them on their list. Why there can't be possibility of insurers and hospitals being hand in gloves such that hospital will levy exorbitant charges, insurers will pass partial amount under garb of reasonable clause thereby limiting the fund outflow and looting the consumer by making him pay the remaining amount?
Whats the use of admitting patient to hospital on empanelled list?
Exactly! Hospitals can get away with this because there is no regulatory body governing such practices. And insurers are quick to shift the blame to hospitals
No regulatory body? Doesn't this fall under purview of irda?
So we are not supposed to tell hospital that we have insurance and get reimbursement later? It's confusing. And does the hospital listen to the patient when they say you must include in OT charges? They would just be like this is our policy. Plus, admission itself is so stressful, we would just want to be done with it and not think about all this.
Hey we want videos with English only because we South Indians doesn't know much hindi ,, so please make videos in English language only
We will add English subtitles in the occasion there are a few Hindi words interspersed in between. We will keep this feedback in mind !
Since we don't know Hindi, We are getting disconnected.My suggestion to have one south Indian so that you have to speak in english.
Please continue your session in English. We are getting disconnected.
We will do this. Thanks
Your videos are viewing over all India, and you know that very well, so I don't think so that I have any right to give you ideas,
You understand very well.
Hey... its so difficult to get in touch withyoyr advisers... its really frustrating sir... from 3 weeks im unable to contact you.
Hey
We are very sorry about this. We have a waiting period because it takes a while for us to train new advisors and we haven’t been able to add as many advisors as we would have liked. We promise to fix this in the coming days
@@dittoinsurance sir then may I know how do you manage after sale of policy and your support is needed at claim time. ?
Sir, what if some one has disclosed pre existing disease like any leg surgery and missed documents related to leg surgery and later he got heart problem and joined hospital.will his claim rejected due to not having pre existing leg surgery documents?
No. That cannot happen. If you have disclosed your condition, then you have nothing to worry. Even if you do not have the documents related to past surgery, then that shouldn’t matter!
I buy a hdfc policy, I sent all pre-existing disease in their email, but they only add some pre-existing disease, when I talk about to add all in policy copy,they said all noted in our end, because other disease not any loading charges so they can't show in policy copy, is there any problem in future of claim which doesn't disclose in policy copy? What should be done??
No need to worry. Once you make a mention of everything in your application, there should be no concerns about claim settlement !
See, there are many Supreme court, NCDRC and other state CDRC's judgements and rulings that fees cannot be fixed by any authority. So, in cases like you said, the complainant can go under the Consumer Protection Act to the concerned consumer district redressal commission.
How to go & complain? What is the process? It has to be via lawyer?
@@yshah84 ok. When the claim is rejected, file a grievance with the insurance company. If there is no reply within 30 days of making the complaint or if you don't like the reply then complain to your insurance ombudsman. These details will be written in your policy wording. If not, it will be on the website.
Many cases will reach this point and settle if genuine. If you are not satisfied with the Insurance Ombudsman's award, then you may go to the district consumer redressal commission with an advocate.
Every policy holder needs to be aware and aware of every single word of his policy. In many cases the policyholder is completely unaware of his policy. So many times they make claims that are not true. So, be informed and responsible.
@@aanandsurati828 Thanks Much for the info 🙏
Eastern and NE indians also don't speak hindi. Kindly make videos in English only. ❤ from NE.
We will change this practice going forward. Thanks
By saying customary and reasonable charges insurance companies doesn't give full claims in sometimes then how can we trust insurance companies if any situation like covid 19 comes again then hospital charges spikes up 50% 100% so during that time also insurance companies will give partial claim or full claim
So insurance companies will not be able to use this clause if they believe there is a legitimate reason for hospitals upping their prices. This depends on circumstance and how well your advisor can bat for you during claims
Is this word reasonable and customary charges issue happens with both insurer tie-up cashless hospitals also or just with non tie-up hospitals only
This is applicable for all insurance policies!
@@dittoinsurance He is asking a different question. Whether full reimbursement issue is also with cashless network hospitals?
In this video host became speaker. 😂😂😂
Hahaha. True. The host who is the speaker in this video is actually one of our founder😅
Appreciated for taking this issue
Thank you so much :)
good explanation
Thanks :)