- It is estimated that currently 10% of the population in Mexico has life insurance and only 1.5% have a Major Medical Expenses policy.
- Covid-19 is considered the most expensive disease in history that insurers have covered because in Mexico alone they have paid 3,217 million dollars for compensation and/or treatment.
- Most of the complaints against a Medical Expense Insurance originate from the ignorance of terms before signing the document.
Prevention is the best strategy to prevent a seemingly small problem from becoming a major nuisance. For this reason, regular medical check-ups are so important. In this way, diseases can be identified from their earliest stages. For people who lack social security, the ideal is to have a Medical Expense Insurance.
However, according to the National Commission for the Protection and Defense of Users of Financial Services (Condusef), complaints and claims against this type of service have increased 28.2%. For its part, the Seguros Defensa Segura law firm affirms that a large part of these disagreements can be avoided if people are advised correctly from the beginning.
Complaints on the rise
The main reason for complaints against insurers is the refusal to pay insurance compensation, which had an annual increase of 36.6%. These refusals may be due to concepts such as ‘pre-existing’, which are illnesses or conditions that the beneficiary had before contracting his medical insurance, and consequently are not covered by the insurance.
Another of the concepts that people should know to avoid claims and rejections of their insurance are the ‘exclusions’. These are illnesses or treatments that the insurer does not cover, for example, congenital conditions, cosmetic surgeries, homeopathic or alternative medicine treatments, psychiatric studies, and accidents or illnesses caused by drug or alcohol use.
“Insurers can also deny payments and compensation related to medical expenses when the insured lied or omitted relevant information about carrying out a high-risk activity, even when this was not the cause of the injury or illness. For example, if the insured’s means of transportation is a motorcycle and he did not report it at the time of contracting his insurance,” adds Alejandro García López.
Due to the foregoing, the insurer has the right to investigate whether the information we offered is true and in the event of detecting any inconsistency, it can terminate the insurance contract and consequently the policy, and in that case, it will not have the obligation to pay any compensation. .
Based on the above, the insurance lawyers of Defensa Segura offer the definitions of some concepts that everyone should know before hiring a Medical Expense Insurance.
- The deductible. It is the contribution that the insured will have to make of the total cost in the case of using the insurance for an accident. It must be considered that the insurer will not pay for accidents or illnesses whose attention or treatment is less than the amount of the deductible. That is, the first expenses that the insured contributes in the event of a claim.
- The coinsurance. Most medical insurance, in addition to the deductible, oblige the beneficiary to be in solidarity with the insurer by paying a part of the expenses, which is called ‘coinsurance’. In general, it is a percentage and some policies use it to compensate, for example, if one is admitted to a hospital with a higher cost than the coverage, while other insurances do not charge it, the truth is that this must be carefully analyzed period, which is also closely related to the amount of the premium to be paid.
- Waiting period. It is the time established in the policy, which begins at the time the insurance is contracted, during which the insurer does not cover the expenses for medical care or treatment of certain illnesses or conditions.
- Compare insurers, products and prices. It is common for the price of the insurance to be the element that most influences the decision, however, it is highly recommended to evaluate and compare the advantages, services and prestige of the company of each option that is considered, to make the best decision.
- Analyze the exact type of coverage needed. Each product differs greatly from one another, and the insurances are ‘tailor-made suits’, so we must be clear about our fundamental expectations and needs, since some luxuries or comforts can considerably increase the price of the policy. The most important thing is to know in detail the premium, the insured sum, the hospital level and the coverage. Likewise, the deductible and coinsurance can make a big difference since they are added values of the insurance.
- Consider the prestige of the insurance company. It is important to do a simple search on the internet about the customer service of the company with which we plan to contract our insurance; remember that sometimes cheap can be very expensive.
- Seek advice from expert insurance agents. Medical expense insurance is a great tool, and what better than a true expert to guide us, both at the time of acquiring it, and to make the most of its benefits and, if necessary, advise us during the accident.
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