Health Insurance Claim: Rising inflation has made medical treatment more expensive, increasing the financial burden on ordinary people. Health insurance and government health schemes help families manage these significant medical expenses. However, many people are unaware of the crucial role the government’s Ayushman Card scheme plays in this regard, or they do not know how to get an Ayushman card made. Additionally, many people lack knowledge about how to avail cashless insurance claims, why claims get rejected, or where to lodge a complaint if a hospital demands excessive charges. Let us explore the answers to these questions in detail.
How to get an Ayushman Bharat Card?
Under the Ayushman Bharat PM-JAY scheme, eligible individuals receive medical treatment facilities at listed hospitals. Eligibility and available benefits depend on government records and scheme guidelines. The Ayushman scheme benefits are now also available to individuals aged 70 years and above.
Obtaining an Ayushman card is a simple process:
first, visit the beneficiary portal and log in using your mobile number via an OTP.
Next, select your state and the scheme. Then, search for your name using details such as your Aadhaar card number. Once eligibility is confirmed, complete the e-KYC process. After the process is complete, you can download the Ayushman card. If you face difficulties with the online application, you can seek assistance from a nearby Common Service Centre (CSC), government hospital, or an Ayushman Mitra desk.
How to avail cashless treatment and health insurance benefits?
If you have health insurance and wish to avail cashless treatment, first verify whether the hospital where you intend to get treated is part of your insurance company’s network. Next, submit your documents to the hospital’s insurance desk.
Typically, the hospital forwards information regarding your illness and treatment to the insurance company. The company then reviews the pre-authorisation request. Once approved, the insurance company settles payment for treatment expenses directly with the hospital. However, certain expenses may not be covered by the policy; in such cases, you will have to pay out-of-pocket. “Cashless” treatment does not necessarily mean that every single expense is free of cost.
What to do if the hospital bill is excessive?
If you take someone to the hospital for treatment and the bill appears inflated, ask to see the itemised bill before making any payment. Verify the cost of each medicine, room charges, and other service fees. If there are discrepancies or issues not covered under the insurance, you can lodge a complaint at the billing desk. If necessary, you can also utilise the insurance company’s grievance redressal process. If the issue remains unresolved, you can file a formal complaint with the appropriate consumer forum. You can escalate insurance-related grievances according to established procedures. You can resolve Ayushman Card issues by lodging a complaint with the relevant government authority.
What is health insurance portability?
If you are dissatisfied with your current health insurance provider, you can transfer (port) your policy to another company, subject to certain conditions. Portability lets you transfer specific policy advantages—such as credit for the waiting period—to the new policy under applicable regulations. Start the portability process well before the policy renewal date, as it involves specific timelines and procedures. Therefore, you should check the current rules with your insurance company before submitting an application.
When are pre-existing diseases treated?
Here, we mean medical conditions that existed before you bought the policy. Conditions such as diabetes, high blood pressure, or asthma are often classified as pre-existing diseases. Private health insurance policies typically impose a waiting period for such conditions, though the duration varies by policy. Therefore, when purchasing a policy, make sure to verify how and when your existing coverage applies. Most importantly, do not conceal any pre-existing illnesses or medical history when buying the policy; providing incorrect or incomplete information can lead to claim-related issues later on.
Reasons why a health insurance claim might be rejected
Several reasons can lead to a health insurance claim being rejected. These include failing to provide accurate information about illnesses at the time of purchase, filing a claim before the waiting period has ended, claiming treatment for an illness not covered under the policy, failing to submit necessary documents, or not notifying the insurance company in a timely manner, among other policy conditions. If your claim is rejected, first request a written reason for the rejection from the insurance company. Subsequently, you can apply for a review or reconsideration through the company’s grievance redressal process. If needed, you can also use standard complaint resolution mechanisms.
What are the benefits of a CGHS card?
The Central Government Health Scheme provides health services to eligible Central Government employees and pensioners. Under this scheme, eligible people get many health facilities as per the rules of the CGHS Wellness Centre and Scheme. These may include OPD consultations, medicines, and treatment facilities in listed hospitals. To get this card, you must apply through the official CGHS portal. The portal may ask for an identity card, photo, and job- or pension-related documents. After verifying the application, beneficiaries can avail the benefits of this card.
How to get treatment in ESIC?
To get treatment in ESIC, employees and their family members receive medical facilities as per the prescribed rules. If ESIC contributions are deducted from your salary, you should know about this card. Through this card, you can access everything from simple illnesses to medical facilities. After that, you can seek further advice from a doctor.