Health Insurance- Sum Insured- Hospital Billing process

I am considering HDFC Optima Restore too.

From what I was informed by Ditto, the unlimited restore is applicable for same illness only when there is a minimum gap of 45 days so clarify this point again once.

raghupro wrote:

I am considering HDFC Optima Restore too.

From what I was informed by Ditto, the unlimited restore is applicable for same illness only when there is a minimum gap of 45 days so clarify this point again once.

Niva Bupa Reassure has same illness+same person

talk to the hospital billing manager and tell them the situation, and they will submit the bill to the insurer in such a way it will not get rejected.

Better take super topups

raghupro wrote:

I am considering HDFC Optima Restore too.

From what I was informed by Ditto, the unlimited restore is applicable for same illness only when there is a minimum gap of 45 days so clarify this point again once.

I am also having optima restore ..can't understand concept of restore benefit

Every company/plan has different T&C for restoration. Many times even sales person doesn't know how it will work or what is hidden T&C in it !!!

raghupro wrote:

I am considering HDFC Optima Restore too.

From what I was informed by Ditto, the unlimited restore is applicable for same illness only when there is a minimum gap of 45 days so clarify this point again once.

Those guys are selling only restore and when questioned about secure, they are diverting the topic. May be, they get more commission in restore plan than secure plan. 

MagicalChat wrote:

Better take super topups

Sometimes, supertop ups have room rent limit and this will add additional burden on us. 

ConfirmPassword wrote:

Sometimes, supertop ups have room rent limit and this will add additional burden on us. 

Jitne Pair  Utni chaddar lo.  

abhi1047 wrote:
I am also having optima restore ..can't understand concept of restore benefit

The concept is clear.

Like in our case, when we exhausted the BSI of 5L to 0 and starting using NCB/Multiplier, it was again restored once to 5L for reuse.

It is just that it can't be used if the claim is more than 5L, which is the topic of discussion over here.

Santushal wrote:

talk to the hospital billing manager and tell them the situation, and they will submit the bill to the insurer in such a way it will not get rejected.

I am just planning for future for unplanned sky-high cardiac/neuro surgeries, which only 1-2% are destined to be performed on. Just don't know we are in which group.😬
Please get the answer, if you have any links.

MagicalChat wrote:

Better take super topups

Super top ups are good, but you would have to go for reimbursement route if it is from other than the current insurer.

And given the critical illness diagnosis of one of our insured member, there is less chance of the current insurer to give us the same.

This query is mainly about the hospital billing process.
"

Are the hospitals allowed by the insurers/Govt to generate multiple bills/claims for the same treatment for non-package/regular admissions? For Example they admit the patient for let's say 5 days and discharge him and settle the bill with insurer for those 5 days. And then again admit him for 5 days and discharge and the cycle continues.

I have heard that many hospitals are very cooperative in this matter, but never experienced this personally.

This method sadly will perhaps fail for treatments, where hospitals have packaged rates where it can go up to 20L for some cardiac/transplant surgeries and up to 50L for some neurosurgeries where some head injury is involved."

Now hospitals may co-operate, later they may not. Or maybe insurance company will ban them from cashless mode. No insurance company is a fool to pay insurance in admission dates 1-5,5-10,10-14. They will come to know...

drjpatwa wrote:
Every company/plan has different T&C for restoration. Many times even sales person doesn't know how it will work or what is hidden T&C in it !!!

please check pm, need health insurance. 

ConfirmPassword wrote:

Those guys are selling only restore and when questioned about secure, they are diverting the topic. May be, they get more commission in restore plan than secure plan. 

Better to consult Beshak dot org for this, as they are not selling any insurance product. So, can be considered more reliable...

gagansc19653 wrote:
Super top ups are good, but you would have to go for reimbursement route if it is from other than the current insurer.

And given the critical illness diagnosis of one of our insured member, there is less chance of the current insurer to give us the same.

This query is mainly about the hospital billing process.
"

Are the hospitals allowed by the insurers/Govt to generate multiple bills/claims for the same treatment for non-package/regular admissions? For Example they admit the patient for let's say 5 days and discharge him and settle the bill with insurer for those 5 days. And then again admit him for 5 days and discharge and the cycle continues.

I have heard that many hospitals are very cooperative in this matter, but never experienced this personally.

This method sadly will perhaps fail for treatments, where hospitals have packaged rates where it can go up to 20L for some cardiac/transplant surgeries and up to 50L for some neurosurgeries where some head injury is involved."

Forget abt hospital, even if they do so insurance company will reject the claim for sure...

drjpatwa wrote:
Forget abt hospital, even if they do so insurance company will reject the claim for sure...

So this restoration benefit seems to be just a gimmick, and will practically fail for claims against expensive surgeries.

So, will upgrade to Optima Secure, or check for Super Top Up from other companies.


Would you recommend buying Super Top up from a insurer other than the base insurer?

Can we settle 2-3L in reimbursement from the base insurer later by paying cash at hospital and file a cashless claim for the remaining 10-15L with the super top up insurer?

gagansc19653 wrote:
So this restoration benefit seems to be just a gimmick, and will practically fail for claims against expensive surgeries.

So, will upgrade to Optima Secure, or check for Super Top Up from other companies.


Would you recommend buying Super Top up from a insurer other than the base insurer?

Can we settle 2-3L in reimbursement from the base insurer later by paying cash at hospital and file a cashless claim for the remaining 10-15L with the super top up insurer?

Better to get 10Lac SI. With 2 NCB, it becomes 20L + 10 Lac(restore)
Should be enough in most case unless you are too unlucky

1. I don't know where you heard such practice. Major hospitals or doctors won't entertain such tricks. Probably lower rung hosp in cities or towns may agree so they can eat away the insurance amount. Even then won't insurer ask why was the patient discharged in the first place? Search for blacklisted hospitals list by insurance companies on internet.

HDFC Optima Secure with 2X base cover from the start.

We can also increase the SI now, but would have to bear fresh waiting periods of 2/3 years for the increased SI, which is not desirable.

That's for the increased sum protection. 🙂 Say your sum insured is 5 lakhs. For waiting periods next 5 lakhs have to be used. But that's okay naa. In Optima Restore you are stuck with 5 lakhs. And for every redemption your NCB will not attract any penalty in Optima Secure. But premiums ll increase every year in increments. That's a downside. In Optima restore you have premiums based on age Bands. 

bikidas2060 wrote:

HDFC Optima Secure with 2X base cover from the start.

We can also increase the SI now, but would have to bear fresh waiting periods of 2/3 years for the increased SI, which is not desirable.

That's for the increased sum protection. 🙂 Say your sum insured is 5 lakhs. For waiting periods next 5 lakhs have to be used. But that's okay naa. In Optima Restore you are stuck with 5 lakhs. And for every redemption your NCB will not attract any penalty in Optima Secure. But premiums ll increase every year in increments. That's a downside. In Optima restore you have premiums based on age Bands. 

how is max/niva bupa reassure?

gagansc19653 wrote:
So this restoration benefit seems to be just a gimmick, and will practically fail for claims against expensive surgeries.

So, will upgrade to Optima Secure, or check for Super Top Up from other companies.


Would you recommend buying Super Top up from a insurer other than the base insurer?

Can we settle 2-3L in reimbursement from the base insurer later by paying cash at hospital and file a cashless claim for the remaining 10-15L with the super top up insurer?

Too much hassle bhai. Always go with your base sum insurer for super top-up. 

There are other conditions associated with super topups. 

Ex: if the base policy allows you for no limit room rent n but your super top-up allows you upto single pvt AC room then you ll be able to avail single pvt AC room only. There are other tnc associated. 

There ll be compromises which have to be made. 🙂

nomag wrote:
how is max/niva bupa reassure?

Very good, if and only if you are very very very open regarding your health conditions. Star, Care, HDFC etc have lenient policies. Sadly Care policies are stupidly designed, some policies don't allow domiciliary treatments, some policies don't allow  consumables benefits even with riders. 

My suggestion, please go with a competent agent. Insurance companies here want to make a profit. They would love to reject a claim. 🙂

Don't go with ditto they are severely biased towards hdfc n care. Don't go with policy bazaar just because you can pay via Amazon balance. 

Go with a proper broker. Cheap is not always the best option .