Q. In case of deficiency in claim documents, how should the insurer communicate with the claimant?

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Q. What are the factors that decide the claim amount payable in health insurance?

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Q. What are "Reasonable and Customary Charges" in the context of health insurance claims?

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Q. How is the claim payment typically made in health insurance?

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Q. What percentage of health insurance claims are usually found not to meet the policy terms?

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Q. What should the insurance company do if it denies a claim?

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Q. What is the primary purpose of cashless settlement in health insurance?

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Q. How does the cashless facility work in health insurance?

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Q. In the cashless settlement process, what is the role of the Third Party Administrator (TPA)?

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Q. What should a health insurance customer do if they don't have their insurance details with them when seeking treatment?

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Q. Why should a health insurance customer check if the hospital suggested by their consulting doctor is in the network of the TPA?

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Q. What happens if incorrect details are entered into the pre-authorization form in the cashless facility process?

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Q. What should a customer do if they decide to admit a patient to a different hospital after obtaining cashless approval at one hospital?

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Q. What is the most important document required to process a health insurance claim?

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Q. What role do investigation reports play in the health insurance claim process?

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Q. Which document helps decide the amount to be paid under a health insurance policy?

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Q. Why is identity proof important in the health insurance claim process?

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Q. What specific documents may be required for accident claims?

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Q. When does the scope of TPA services in health insurance typically begin?

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Q. What is the primary purpose of TPA enrollment of members in health insurance?

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