Bangalore: Many benefits have been listed of having a medical insurance policy but then it requires the individual to run around for the claims process. To reduce the running around a bit it’s essential to be aware of the basic conditions laid out in the insurance contract, and keeping aside the troubles of both during and post hospitalization.

The insurance battle starts when the private hospitals wish to generate more and more revenue and so they encourage patients covered by medical insurance policy to undergo medical procedures which are sometimes unnecessary and then the health insurers reject the claim saying that it was irrelevant. There are some exemplary steps that one must take in order to avoid the hassle.

1. Before Getting Hospitalized

It is important to select a hospital that asserts for a registration certificate unless it’s an emergency visit, because in few cases the insurers have rejected health insurance claims stating that the hospital did not have a valid certificate. Dr. Nayan Shah, Chairman and Managing Director at Paramount Health Services, a third party administrator tells The Economic Times, “In urban areas, an approved hospital should have more than 15 beds, while in level-B cities, the minimum criteria is 10 beds.”

MD Garde who serves as an independent consultant to insurance companies says, “Choose a hospital only after checking the list on the website of the TPA or calling them up, as every year they downgrade some hospitals and remove some.” The issue of the guidelines drafted by the Insurance Regulatory and Development Authority to protect the interest of health insurance policy holders has to be confronted.

In one of the proposals suggested by the authority was, “Where a policyholder has been issued a pre-authorization for the conduct of a procedure in a given hospital or if he is already undergoing treatment, and the hospital is proposed to be removed from the list of network provider, the insurer will provide the benefits of cashless facility for the policyholder.” One must take the prior approval from the insurer before visiting a hospital so that even if the hospital’s name is removed from the insurance company’s list later.