Q. My health insurance company is not renewing my existing policy. Are they authorized to do so?
A. check if your policy is guaranteed renewable, if it is not then the insurance company is authorized to deny renewal. Kindly refer to the terms and conditions in the policy document that you signed.

Q. What is the time period in which the insurance company has to either pay or deny the claim?
A. According to the latest amendments the insurance company has 45 days to either pay or deny the claim.

Q. I had an open heart surgery recently costing around $20,000 but the insurance company agreed to pay only $11,000 which is $9000 less and I don’t have money to pay the reminder, what should I do?
A.The insurance company must have arrived at the reasonable and customary rates which is always lower than the actual cost of the claim. What you can do now is that you can request to the doctor or the insurance company to recalculate the claim and figure some way out.

Q. The insurance company is delaying paying my hospital claim. They argue that they are analyzing the pre-existing condition. Can you assist in this matter?
A. If your insurance policy is two years old than the company should not go for a pre-existing condition investigation. However, if the insurance policy is less than two years old it needs to be investigated for pre-existing condition. Although if it is intentional on the part of the insurance company that they are delaying the claim then you can file a complaint to the authorities.

Q. My insurance company has cancelled my health insurance policy. What does this mean?
A. Rescission or cancellation can be due to many reasons. It occurs as a result of incomplete or inaccurate information submitted on the application, or an omission of information that is mandatory. Check if you unintentionally submitted wrong or incomplete information to the insurance company.

Q. What is a PPO plan?
A. A PPO (Preferred Provider Organization) plan is a plan where preferred providers of service (including doctors and hospitals) have a contract with an insurance company or a health plan to offer service for their policyholders. Generally, the preferred service provider agreed to accept an insurance company's usual and customary payment. If you have a PPO contract, and do not use the preferred service providers, you may find yourself paying more for services rendered by the physician or hospital.

Q. I applied for health insurance policy 2 months back and then I was ill for some time I got the bills of the doctor and the hospital, but now the insurance company tells me that I am not insured, can I sue the company?
A. The health insurance policy is not applicable unless the policy is not accepted by the insurance company after due procedures of investigation. Only paying the premium does not bind the company to pay the medical bills as well.

Q. My health insurance company has reduced my benefit payment. They say that I need to pre-certify my hospital stay. Are they authorized to do so?
A. Kindly read the terms and conditions written on the policy document also look at the section with the heading pre-certification to know more about the per-certification of the hospitals.

Q. How long does it take for a policy to be issued?
A. The maximum duration for the policy document to reach you is 60 days however the time period may differ based on the pre-existing condition investigations.

Q. Our employer is changing the healthcare benefits to a lower level. Can he do that?
A. Yes. It is because that the insurance contract is that of a group insurance and it is also between the policyholder (the employer) and the insurance company.