Health Insurance Reasonable & Customary Clause EXPLAINED | in Hindi | Gurleen Kaur Tikku
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- Опубликовано: 31 июл 2024
- In India, there is no regulation that places a limit on how much a hospital can charge for a particular service.
If the hospital charges significantly more than other hospitals in that same area for the same treatment, the insurer can refuse to pay the overcharged amount and pay only the standard rates charged by similar graded hospitals in the same area, under the ‘Reasonable and Customary’ condition in every health insurance policy.
WATCH THE VIDEO FOR MORE DETAILS :)
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✅ TIME STAMPS :-
0:00 Example
0:50 Introduction
2:19 Identify Reasonable & Unreasonable Amount
3:16 Protect yourself from Customary & Reasonable Clause
3:56 Example
4:39 Negotiate with Hospitals
4:51 Find alternate hospitals
5:03 Pay Claim Differential yourself
5:14 Reimburse Hospital Bills
5:46 Conclusion
6:21 Bloopers
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Disclaimer : Information presented in this video is for educational purpose only. It may not necessarily be taken as financial, legal or any other type of advice. It is not as per individual needs, objectives or financial situation of any particular person.The video is based on 17 years of experience of Financial industry.
It is based on researches from various books, internet etc and may include opinions of one or more persons who may or may not be the part of Hareepatti.
Gurleen Kaur Tikku or any other team member of Hareepatti will not hold be held responsible as this is not to be considered as personal finance advise.The video does not mean to hurt anyone’s sentiments or spread rumours of any sorts.Viewers should do their own due diligence before taking any action based on the video.
Viewers discretion is advised. 
Кино
Thank you very much for your clear and valuable information mam.
Thanks a lot, keep watching !
Secondly as someone commented here in network hospitals it is the responsibility of the insurer to negotiate with the hospital which seems to be fairly correct.
Thanks for the information.
Customer feedback: Price rationalisation needs to be done by insurer also. They will not do that only because they can show people the spiraling health cost. For this reason insurance company keeps blind eye on overcharging by hospital. Now coming up with these clauses to suffer customers. It is time customer should know the ratio of enforcement of these clause by each insurers. Will provide feedback to IRDA website on this. If this ratio is high then change your insurer.
I agree with you Sir
First of all Most of the public emergency time jaate hai hospital tab hospital apke majboori ka faida uthaega or negotiate nai krega or us time 2,3 hospital Jake check krne ka bhi time nai rahega
will it apply even in network hospitals? if yes then is it not the responsibility of insurer to negotiate with the hospital?
Where one can see this in his or her er policy...i read entire policy wording.. cant find reasaoble and customary clause
While in reimbursement the RNC deducted amount is bear by the patient there is no any other way
So Many If & But In Health Insurance
This Is Only The Reason People Don't Purchase
Some Time Partially Claim Pass & Some time Full Reject
I Know Health Insurance Is Important
In fact I Am Bramch Operation Manager In Bank & I Have Supported My All Staff Medical Claim Assistant All Are Settled But This happen In Group Mediclaim
Personal Mediclaim Policy Have So Many Confusion
Very important information. New to me thank you
Glad it was helpful, keep watching !
Very informative, thanks a lot👍👍
Glad it was helpful!
I have got enough information....thanx
Thank you, keep watching !
How is it possible in emergency hospitalization?? Aap toh planned hospitalisation ke baare mein bata rahi ho Ma'am...
Nivabupa approv fo cataract surgery done with monofocal lense
Why?? Like Rs. 40k to 42 k
It is fair??
Very very informative video Gurleen mam.. what is itemized bills by hospital.. please guide.Thank you.
Thank you so much. Itemized Bill lists all the details, including the cost of each item purchased rather than just the total cost.
गुरलीन जी अगर मेरे पास दो इन्शुरन्स है दोनों ५ लाख का है और मेरा ट्रीटमेंट कॉस्ट 8 लाख की है तोह मैं दोनों से कैसे क्लेम ले सख्त हूँ। डिटेल में बताएं।
We have a video on this as well. Please check this link : ruclips.net/video/uUbeZZebDdM/видео.html
Thank you
Mam insurance me 80 D clause kya hai
Ma'am, suppose I need to plan a surgery and I plan it in Apollo Hospital. So it's acceptable that insurer compares it's bill with that of Max Hospital. But what if they compare it with National Heart Institute which is not of similar level as Max and Apollo and reimburse lesser amount to me? Can they do so??
Mam emergency me paisent ko bachane ke bare mein deke ge
Ya ko n sa hosp ital kam charge lega ye dekte rahege is ka matalab health policy lene par loss hai pls bataye explain pls bataye 🙏🏻
Ypu Arw Right
Personal Mediclaim Policy Has So Many If & But
This clause is made so that hospitals don't overcharge- they will charge in sync with what other hospitals are charging and what is reasonable.
The clause is made to protect insurers.
Madam meh ne Niva Bupa ka health policy liya tha 4 Jan 2023 ko policybazar se. Mera father ka surname Galat print hoke aya. Aj tak.policybazar ne name correct karke nehi Diya meh ab kya Karu??? please help....
How i can apply for mwp act when buying any insurance policy online and if online policy form doesn't have any option for mwp act benefits than what it the process to apply. Please make a video bcz there is no video on youtube which provide the full process about this.
Mam ek video child insurance plan par bhi bna do aap
Ji, Thank you for the suggestion. We will bring a video soon. Keep Watching !
@@GurleenKaurTikku mam still waiting for video
mam apne koun si health insurance li hui hai ?
Niva Bupa Health Companion.
Mam
I want to buy policy from policy bazar.
Is it good ? Will they help in claim settlement.
Or I should buy frm any where
Suggest you get in touch with a known health insurance advisor, who will stand by you during claim.
You can connect with us on WhatsApp/Call at 9650706699. Our team will be happy to assist you in choosing a suitable plan. Also, we have an experience of 17+ years in insurance industry.
Medical expenses means those expenses that an Insured Person has necessarily and actually incurred for medical treatment on account of Illness or Accident on the advice of a Medical Practitioner, as long as these are no more than would have been payable if the Insured Person had not been insured and no more than other Hospitals or doctors in the same locality would have charged for the same medical treatment. This is the definition of 'Medical Expenses' given in my policy. It seems so similar to reasonable and customary clause. Is it the same thing??
if u would have to pick one company, which will be your choice in health insurance? which company u think is best overall in health insurance sector!
We have a good first hand experience with HDFC ERGO & Niva Bupa Health Insurance but it can definitely vary for you. You should choose a plan according to your requirements .
We have videos available on our channel, please check !
Keep Watching !
@@GurleenKaurTikku thanks for taking out time and replying ❤️
This is for planned surgery
For emergency there is no room for bargaining
Then its the responsibility of the insurer but sadly this is india
If someone rushed to hospital and it is critical and cannot go for any other hospital or can not negotiate due to surgery emergency, then what need do. Pls explain.
What if I take treatment or surgery in Deluxe/Super Deluxe Room, where prices decided as per Room Category? Please confirm whether that will be payable according to room category? My room eligibility is upto Super Deluxe Room.
Yes, it will be paid as per your eligible room category
Shall I go for Navi insurance for health
We don't have any first hand experience, so can't comment on that.
If you want to buy health insurance or want any assistance, you can connect with us on WhatsApp/Call at 9650706699 .
Our team can assist you.
Thank you
Mam can two engaged but unmarried persons buy health insurance together?
No, you can't. You can buy 2 individual policies currently.
For any queries, you can fill up this form & our team can connect with you directly.
FORM LINK : hareepatti.com/contact-us/
Thank you
Suggest a good health insurance for 58 yrs female with diabetes and BP.
You can go with Niva Bupa ReAssure plan with it's rider. If you want any assistance, feel free to connect with us on WhatsApp/Call at 9650706699.
Thank you
Dear Mam,
My newborn baby is in NICU and hospital does not have cashless facility.
Request to help me to know, can I request mediclaim policy company to provide cashless service to non-network or not in list hospitals.
No, it can't be done. You have to go for reimbursement only.
If a person goes for specific surgery then it can be ascertained through pre authorisation if the hospital is charging within the permissible limit or not. But if a person is admitted in an emergency and it is not a surgery case then how will a person protect from this customary reasonable clause. You didn’t clear it here. You should have talked about non surgery case too where how one can safeguard from this clause.
My concern is also same,in emergency if someone has to be admitted then ??
This clause is made so that hospitals don't overcharge- they will charge in sync with what other hospitals are charging and what is reasonable.
The clause is made to protect insurers.
Ma'am, isnt it a scam that if a hosptial is in network list of a Insurance company that means hospital is good and it has dedicated desk of insurance company representative at the hospital for cashless.
Now when a person who has a policy from 3 yars and now getting x treatment and its charges are 6 lakh and at the moment sum assured is 10lakh but this time insurance company will say bill is overcharged we can approve 4 lakh only.
This is a clear scam if a hospital is under network list that means its a whitelisted hospital all parameters are priorly checked by insurance company and that why its a one of network.
How come a customery clause is used at the time of cliam stelment to scam the patient.
It was a cashless right.
I hear you and feel you, but health insurance companies have their own constraints.
I hope things will be better in future with health industry evolving
Pls answer mam
- Health insurance bought in Dec’19 for 10L.
- Renewed it & enhanced sum insured to 20L next year, Dec’20.
- Wife diagnosed with hypothyroid in Apr’21.
- Renewed it for this year in Dec’22 but did not declare hypothyroid as a PED.
Should we declare it now ?
You don't need to. You can but you're not necessarily required to. It's not PED since it was diagnosed after purchasing the insurance.
How come insurance company would say no because there no clause how they reject claim because 10lakh is sum insured 🤔
They will if it is more than their agreed rates.many policies have sublimits, Pl check that carefully
Here, claim was not rejected but settled partially because of this clause
Hi mam....
Can campare merits & demerits of Nivi reassure plan vs Manipal prime Advantage plan.....with ADDON ALSO..PLZZ..Ur ultimate to explain 🎉🎉🎉really waiting for long time....if possible add HDFC ALSO..
Thank you for the video suggestion, we will try to bring up a video soon.
Keep Watching 😊
Still not posted video of. Plzz compare
New India Yuva policy vs national youth policy vs young star policy video kab ayega? Madam I know you don’t charge us for videos.. then I have no right to tell you what to do or not.. But I am asking you for the video for about four months… It is my last request… I am not blackmailing.. Just upset.. If you have any business motive then put it.. it’s ok.. please don’t tell request noted… I want a suggestions for buying policy.. It is too long to wait.. If you have any specific date then reply or I will understand
Toh kya fayda phir 1 cr ki insurance lene ka 😢😢
This is important as well for the insurance companies .
Also, you should buy sufficient health cover.
@@GurleenKaurTikku mam insurance policy me har ek disease jo cover hai ,uske reasonable charges हमे कैसे पता चलेंगे? Taki hum hospital ko compare kar sake ki kaha treatment karana hai