Insurance Limit Exceeds for Delivery

If the expense of the treatment has exceeded the insurance coverage, the option is to pay this from your side. Neither the insurance company or organization will pay in most cases. You can ask the hospital to reduce the amount, since you will be paying this from yourself and they might reduce the amount.

HRGuru wrote:

If the expense of the treatment has exceeded the insurance coverage, the option is to pay this from your side. Neither the insurance company or organization will pay in most cases. You can ask the hospital to reduce the amount, since you will be paying this from yourself and they might reduce the amount.

Yea that, this happens in most cases.

Good luck.

wsmhagazi wrote:

insurance limit exceeded for CS Delivery in Dallah Hospital. and they are asking for 5000 More.
Any body knows how to get the Full Coverage Detail for Insurance (AXA Insurance A Class).
I called my company they said cannot do any thing.
AXA Company representative says limit is only 15000.
How can it be for A Class?

The limit of 15,000 in most A-class policies is for normal delivery and Ante Natal Care.
The limit of Cesarean is  the limit of your policy. In most A class policies it is 250,000 SAR which is usually sufficient to cover all expenditures. This must be written in the policy documents you got with your cards.

So, I'm sure you have a valid case here --- unless Dallah has really exceeded 250,000 (I've assumed this number, the exact is in your policy docs).

The limit of 15,000 in most A-class policies is for [b wrote:

normal[/b] delivery and Ante Natal Care.
The limit of Cesarean is  the limit of your policy. In most A class policies it is 250,000 SAR which is usually sufficient to cover all expenditures. This must be written in the policy documents you got with your cards.

So, I'm sure you have a valid case here --- unless Dallah has really exceeded 250,000 (I've assumed this number, the exact is in your policy docs).

I called the Insurance Company Many times, they said that 15000 is limit for Normal or CS Delivery.
Policy limit is 500K.

CS Delivery package in Dallah with 4 Days Room is 17K+ SR.

An example to clarify my point:



See the Normal delivery limit here is 15,000 SAR for all classes (even C and VIP+).
But the C-section is specified as 'covered' that links back to the total amount insured for the person. In above case it's 500.000 SAR. This is as per CCHI ruling.

You must have a similar paper coming in your insurance policy card package. Review it in the similar way.

For the sake of swiftness, you may pay now but raise a claim with AXA for reimbursement.

One more thing: Calling would NOT yield much, try to visit their claim center and talk to someone senior.

TheLegendLeads wrote:

Thank you very much.

Actually my contract with Company finished and waiting for renew. and they don't give us any kind of documents.

Where to get the Full policy Detail? or Download?

Are you able to resolve this?

i got the policy details from company and it mentioned that pregnancy limit (c-sec or normal) is 15000 SR .. Strange
Company told me that there is no option to get the money that i have paid at hospital.