Building Confidence and Preparedness in Managing Health Insurance

Having health insurance is confusing for many, with the variety of policies, medical terms, exclusions and the claims process can be over-taxing. However, the comfort with which one can deal with health insurance issues directly impacts financial security and access to health care during crisis. A well-prepared, confident policy holder can manage a medical emergency with fewer hassles, fewer delays, fewer poor decisions and his or her financial loss will be less. Conversely, an unprepared policy holder can have a host of avoidable practical issues. Many people purchase a policy thinking it will take care of them when the time comes, but the test occurs when documents, hospital networks, claims and coverage limits all become an issue in the middle of a stressful time. Having a health insurance policy is not enough; preparedness is just as important: it's not only about having the right health insurance policy, it's about having it available when you need it and for the right reasons!

Preparedness goes beyond paperwork, too a family may be able to deal with a mild case of food poisoning at home if they know these few home remedies.

The first step to confidence is knowledge of the policy itself. Most policyholders only consider the insurance when there is a crisis and get caught off guard on coverage, exclusions, waiting periods, room rent caps, or how to submit a claim. Many people put their papers off to the side immediately after purchasing a policy, and never look at them again, leaving them with important information when they might need it the most. By being aware of the sum insured, network hospitals, cashless treatment options, waiting period policy, coverage exclusions, room rent limits and co-payment clauses before the issue, people can minimize the unpleasant surprises during an emergency and maximize utilization of their policy. Understanding the difference between cashless (when the policyholder is treated at a network hospital without paying the entire bill up front) and reimbursement (when the bill is paid first and documents submitted later for reimbursement) can be useful as well as understanding who to contact, what paperwork is required and how claims are processed for approval. This sort of preparedness reduces confusion while in the hospital, helps to facilitate faster decision making in the event of an emergency and helps prevent claims delays because of missing paperwork or incorrect information — even minor delays can contribute significantly to stress for patients and families when the situation is already stressful.

Part of preparedness is also understanding that there are consequences to being unprepared. When customers don't review their hospital network before admission, they often assume that hospitals won't be on their approved network until they get there. Some can still find themselves not having the necessary documents when they have to claim, and some may not alert their insurance provider in time when they're admitted to an emergency room situation, which can delay claims and increase short-term out-of-pocket expenses. Many times, claim problems are not due to a gap in the policy, rather it is due to a lack of understanding on the part of the policyholder. Family members are important here as well: They are likely the people who need to deal with formalities at the hospital when the insured member is sick, so it is important to ensure that they understand policy provisions and know where documents are stored and who to contact to avoid most important delays at the time of need.

Healthcare requirements evolve over time — as our age, lifestyle, family circumstances or new health conditions change — and medical inflation can render our policy that seemed like enough a few years ago inadequate today. Having regular coverage reviews allows policyholders to increase coverage, include members of their families, buy top-up coverage, change nominee provisions, and even include critical illness coverage, and keep the policy in line with their present and future needs. This is an anticipatory practice that contributes to the financial literacy that will help individuals make more informed, rational decisions in the event of a financial emergency rather than just a rush decision and can be linked to a wider awareness of the financial cost of hospitalisation, surgery, medication and long-term treatment. A person who makes a conscious effort to stay engaged with their policy, and not consider it another financial product that's stored in a drawer, is better prepared to deal with events in an emergency calmly. Several insurance companies, such as Star Health Insurance, now facilitate this by providing access to their policy documents, claim tracking, and information about their hospital network online.

Similarly, common complaints — if you have a few tried remedies for dry cough at the ready, you may avoid an extra visit to your clinic for a typical seasonal cough.
There are a few concrete practices that foster this sort of preparedness and there's really something to be said for using it as a checklist instead of a one-off. Knowing what is and isn't covered helps from the outset to avoid confusion when treating. Ahead of time check of the network hospital list helps to smooth the cashless claims process, rather than scrabbling at the admission desk. It saves claims from being delayed when they are submitted for processing later. The renewal date tracking feature avoid lapse in policy as it would disrupt the continuity of coverage. Knowing basic information — where the documents are stored, which hospitals are in-network, who's to call — greatly helps family members during the emergency situations in which the policyholder may not be able to manage.

Putting Health Insurance Papers in order.

Another related aspect of preparedness is to ensure that insurance policies are kept in order, as misplaced or disorganisation of documents can cause stress and cause delay when needed most — during hospitalization or settling the claim. Important documents may be lost in drawers or scattered in various locations, making it difficult to locate a specific document when it is needed. Commonly in health insurance policies there is information regarding the coverage provided, waiting periods, exclusions, the process for making a claim, and payment of premiums; this information is needed at the time of hospital admission, when a claim is filed, at the health insurance renewal, or when personal information needs to be updated. Paperwork that has not been organised or is missing can make it much harder to make a claim or to understand policy benefits, while being organised makes it much easier to communicate with the insurer and makes it easier for the policyholder to respond promptly if the insurer asks for paperwork.

The policyholder should keep the policy document, health insurance card, identity proof, receipts of premium payments, previous health records, hospital bills and any documents related to the claims together and easily accessible. Each has a specific function: the policy document provides coverage information and conditions, premium receipts provide evidence of premium payments, the health card is used at the time of hospital admission, medical reports are required in the process of claims, hospital bills are required for reimbursement claims, and identity proof helps to verify. Records from past discharge summaries, prescriptions and diagnostic reports are also beneficial to keep as they may contribute to future claims, or confirm policy history.

Good habits really count. Maintaining both physical and digital copies – in a secure scanning app, a laptop or a cloud-based storage system, and clearly labelled into a folder – is one of the easiest protective measures, and ensures that a lost or destroyed hard copy is never the only backup. Documents should be checked on a regular basis and any changes to policies, addresses or nominees should be made promptly, as out-of-date documents can lead to misunderstandings later on when there are discrepancies, at the very last moment. It's also easy to forget to tell your family where insurance papers are kept, and in an emergency, if insurance documents and health cards are readily available, the hospital will admit you and assist with claims, especially when it's a family member who is handling the hospital forms. Another easy habit is setting reminders on premium payment dates, so that you don't miss a coverage period and it doesn't affect the continuity of coverage or the claims process later.

Common pitfalls to avoid include: storing only digital copies without a backup, losing originals after a renewal, missing deadlines, not updating nominee information and not holding complete medical information. Again, Star Health Insurance has such an app that will enable the policyholders to organise their records, and access them as and when they want to, cutting down on the manual work with regard to keeping them organised.

The principles are the same – build confidence or build preparedness – but the strategies are the same: know what the policy actually covers; have documents organised and accessible; know the claims process before they need it; review what is covered as life changes; keep family members informed. These simple, frequent changes can make a difference in minimizing confusion, saving time, and providing smoother support when it is most needed – all when health insurance is most needed.

NOTE: This article is written by Brand Desk.