Health Insurance claims: 6 common reasons insurers deduct money from your settlement

The article explains six common reasons insurers deduct money from health insurance claim settlements. First, 'Reasonable and customary charges' refer to insurers paying only standard amounts for treatments, with excess costs potentially excluded, especially in non-network hospitals. Second, 'MoU discounts' are contractual reductions between hospitals and insurers, which should not be passed to policyholders if explicitly stated. Third, 'No active line of treatment' occurs when hospitalization lacks medically necessary active care, such as for diagnostics or observation. Fourth, 'Experimental or investigational treatment' may be rejected if not recognized as standard care under the policy. Fifth, 'Consumables' like gloves or syringes may be excluded unless explicitly covered. Sixth, 'Liability could not be ascertained' arises when insufficient medical documentation prevents insurers from determining responsibility. Lastly, 'Room category and proportionate deductions' occur when policyholders choose rooms exceeding their policy's eligible category. The article advises policyholders to request itemized bills, clarify deductions, and consult the Insurance Ombudsman if disputes arise. It emphasizes understanding policy terms and IRDAI guidelines to avoid unexpected claim reductions.

(Source：Mint)