Will your health insurance plan pay, if the hospital overcharges?
🤔Your heart: I feel the hospital is overcharging for this procedure.
👿Your mind: So what? I have health insurance.
🥱Your Health Insurance Plan: What? Really? I won’t pay for this extravagance!
A thread🧵
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🤔Your heart: I feel the hospital is overcharging for this procedure.
👿Your mind: So what? I have health insurance.
🥱Your Health Insurance Plan: What? Really? I won’t pay for this extravagance!
A thread🧵
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Some hospitals have been reported to overcharge even 30-50% higher when compared to other similar graded hospitals.
Especially when they know you have insurance. 😮☂️
Insurers are aware of this & have a way to protect themselves from such excessive billing.
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Especially when they know you have insurance. 😮☂️
Insurers are aware of this & have a way to protect themselves from such excessive billing.
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Every policy’s fine print has something known as ‘Reasonable & Customary Clause’. Based on this clause, insurers can deduct any overcharging in hospital bills.
Yes, that means, you pay the remaining cost out of your pocket!😳
Yes, that means, you pay the remaining cost out of your pocket!😳
How do you protect yourself in all this? Read on below.
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When an insurer receives a bill & finds the pricing fishy, they compare costs to the 'normal range' - cost of the treatment in other similar grade hospitals, in the same area.
If the difference is not much, they pass the claim.
Otherwise, a part of the claim is deducted.
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If the difference is not much, they pass the claim.
Otherwise, a part of the claim is deducted.
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What can you do about it? 🤔
👉Be aware that insurers won’t pay for overcharging.
👉Wherever possible, take cost estimates from a couple of nearby hospitals & compare them to your hospital’s estimate.
👉If the difference is small - it’s fine. There’s no need to worry. 😄
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👉Be aware that insurers won’t pay for overcharging.
👉Wherever possible, take cost estimates from a couple of nearby hospitals & compare them to your hospital’s estimate.
👉If the difference is small - it’s fine. There’s no need to worry. 😄
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If the difference is big-
👉Negotiate with your hospital to reduce the costs (Yes, this is possible)
👉Get treated in a hospital that charges reasonably
👉Prepare to foot the balance bill from your pocket
👉Negotiate with your hospital to reduce the costs (Yes, this is possible)
👉Get treated in a hospital that charges reasonably
👉Prepare to foot the balance bill from your pocket
Of course, this is applicable for planned & not emergency hospitalizations.
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Follow the golden rule: Always treat every expense as if you were paying it on your own, even if it is insured.
Applying prudence in your decisions with or without insurance always goes a long way - you save on deductions as well as the sum insured for the remaining year.
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Applying prudence in your decisions with or without insurance always goes a long way - you save on deductions as well as the sum insured for the remaining year.
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If you don’t do your bit - the insurer will be forced to take measures to protect themselves.
And invariably, that will mean - you pay the excess costs. 😩
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And invariably, that will mean - you pay the excess costs. 😩
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Want to learn about the reasonable and customary clause in detail?
Check out this article 👇 beshak.org
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Check out this article 👇 beshak.org
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