Can You Claim Nursing Charges Under The Medical Policy?

Jun 29, 2018 | 5 months ago | Read Time: 2 minutes | By iKnowledge Team

Ever faced a situation wherein you have incurred a medical expense and when reimbursed it with the insurance company, they refused to do so? Wonder why this happens? The reason behind this is the coverage of medical expenses as per your policy.  It is important to know what all that your medical policy covers to avoid a situation where the insurance company refuses to pay certain hospital charges.

Unexpected medical contingencies give no prior notion and arrive unannounced. Sometimes even a minor accident can have heavy ramifications on your wallet. Let’s take the example of the Kumar family. Mr Kumar met with a minor bike accident and suffered from a fractured leg. For this, he was advised bed rest for 50 odd days. The family decided to hire a full-time attendant who charged them Rs. 500 per day. They were under the impression that they could get the amount reimbursed by the medical insurance company later. Conversely, the insurance company backed out from paying the amount as they do not accept the charges for nurses.

 So, What Exactly Does Medical Insurance Policy Cover?

When you buy a medical policy, it covers the following expenses:

  • Ambulance service
  • Emergency services
  • Hospital expenses like surgery.
  • Maternity and new-born care
  • Mental health and substance use disorder services (inclusive of counselling and psychotherapy)
  • Prescription drugs
  • Habilitative and rehabilitative services and devices (which helps individuals cope with injuries, disabilities, chronic conditions, or recover mental/physical skills)
  • Preventive and wellness services and chronic disease management
  • Laboratory services
  • Paediatric services
  • Post-hospitalisation services

What Does Post-Hospital Charges Cover?

Medical insurance policies cover post-hospital expenses related to consultation fees, diagnostic charges and medicine costs. You can claim these expenses once you have submitted the original bills, doctor’s certificate, and a discharge summary.

When you purchase a medical insurance policy, it covers the expenses incurred for a defined number of days which varies from one health insurance provider to another. That said, the hospital charges incurred in a specified period is payable by the insurance company, provided that the hospital costs are for the same medical condition for which the insured individual was hospitalised, and the in-patient hospital costs claim is admissible by the insurance company. The cost of hiring an attendant or a nurse is usually not covered by post-hospitalization charges and hence is not payable by insurance.

What If My Insurance Doesn’t Cover a Certain Expense Like That Of Nursing Charges?

In most cases, the medical treatment recommended by a doctor is covered by a medical policy. However, there might be a few exceptions, when you have a test or treatment like the expenses of hiring an attendant which is not covered by your insurance policy, this situation is called “denying the claim”. That said, you can still pursue your insurance company to cover the expenses with the right to appeal the decision. Before that, do get acquainted with the appeal process of your insurance company which should be discussed in your plan handbook.

To Summaries

To avoid the occurrence of such situations, it is best to be well-versed with your medical insurance policy. While you buy a medical policy, make sure you read the fine-print thoroughly and ask necessary questions to your insurer at the time of buying an insurance. Also, remember to get your medical insurance policy with Aegon Life Insurance’s iTerm plus to take care of any unforeseen circumstances hassle-free.

Advt. no.: IA/Jun 2018/4135


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