We at Nova Benefits provide (free) claims concierge services to anyone in an emergency. Such was the case when a policyholder reached out to us due to a case of delay in approval of a claim for cash reimbursement.
A BRIEF DESCRIPTION OF THE ENTIRE SITUATION:
A few days back, a corporate policyholder in dire need of assistance, reached out to a team member at Nova. The individual in question had two family members admitted in the hospital. Her husband was admitted for Covid-19 treatment and was in quarantine although he had tested negative. The employee had made a cashless claim for her husband’s treatment.
The policyholder’s father-in-law had been admitted to the hospital twice. For the initial treatment she was able to successfully retrieve the cashless claim. During the time of the second hospitalization, unfortunately the father-in-law passed away.
Due to his sudden demise, her husband was discharged on an urgent basis which led to the employee making a cash payment for her husband’s treatment as a cashless claim cannot be done at the time of an urgent discharge.
It was a few days after this that she reached out to Nova for help. The policyholder was already under a lot of stress due to the sudden death of her father-in-law and wanted to ensure that she could register the claim for reimbursement for her husband’s treatment quickly so as to avoid any further delay. (Usually such claims need to be made within 30 days otherwise the policy holder is required to provide additional documents, causing further delay)
HOW DID NOVA HELP THE EMPLOYEE?
Once, the policyholder reached out to us, Nova stepped in to initially register the claim as quickly as possible. Nova asked the her to send in a cancelled cheque and other required documents to the insurer.
Due to the sudden demise of the father-in-law, she did not have all the necessary documents with her, including the cancelled cheque which did not have her name printed on it. Even so, we asked her to submit the initial documents to begin with the process of registering the claim.
The policyholder then received the query for the cancelled cheque, and went to the office to submit another cancelled cheque. It was during this visit to the office that information was received that no clear tracking was being done of the claim.
The insurer then asked her to submit the hospital bill paid receipt. Unfortunately, she had lost some of the bills while visiting her native place for the funeral. This caused a major issue in the process but Nova’s team member began talking to a member of the insurance company to come up with an alternative solution. It was then that we were informed that this claim was not tagged as a corporate policy but a retail one. And when the insurer checked under retail policy, they were unable to find a matching policy-holder causing even further delay to the claim. Nova then suggested using the holder’s insurance card to tag the claim.
After this, we asked her to get the duplicate bills of payment from the hospital while the insurer stated that we would have to submit an affidavit along with the duplicate bill in order to process the claim.
Thankfully, during this process the original bills were found, and submitted to finally receive approval for the claim after a long duration of 53 days.
Insurance Claim procedures can be confusing and tiring. We at Nova Benefits aim to help make the process easier for you by extending our claims concierge services for free. Reach out to us in case you have any queries pertaining to your Health Insurance and we will try our best to help!