<section style="text-align: center"><a target="_blank" href="http://mp.weixin.qq.com/s?__biz=MjM5MjY4MjU0MQ==&mid=2447790313&idx=2&sn=55e0cf403a3327c58f7dfcc77ea888c8&chksm=b2b077ab85c7febda44a18349455223c46e61a6d8082f6f51e7dcbb9a81e93eba23d8e4d1845&scene=21#wechat_redirect" textvalue="你已选中了添加链接的内容" tab="innerlink"><span ><img src="/api/reviews/image?src=https%3A%2F%2Fmmbiz.qpic.cn%2Fmmbiz_jpg%2FaqibLpHUEczumlIjBLZrue85Zs0n2A3zNnSqgCRutnu07hVYDTaDvjaicnCrTv9UI0fbJ6w44c5MSacJibTfkyMgA%2F640%3Fwx_fmt%3Djpeg" data-origin="https://mmbiz.qpic.cn/mmbiz_jpg/aqibLpHUEczumlIjBLZrue85Zs0n2A3zNnSqgCRutnu07hVYDTaDvjaicnCrTv9UI0fbJ6w44c5MSacJibTfkyMgA/640?wx_fmt=jpeg" alt="懂保爷测评配图" loading="lazy" /></span></a></section><section style="text-align: center"><span style="color: rgb(136, 136, 136)">点上方图片看看【封面图的故事】</span><br /></section><p ><br /></p><p ><span >本期的分享案例是一起曲折的<strong>小额医疗险</strong>出险案例，</span></p><p ><span ><br /></span></p><p ><span >孩子确诊腺样体肥大，保险公司一度<strong>拒赔</strong>，最终在多方努力下获赔5172.01元。</span></p><p ><span ><br /></span></p><p ><span >下面我们一起看下。</span></p><p ><br /></p><section ><span ><section ><section style="text-align: left"><section ><section style="color: rgb(50, 135, 156)"><section style="text-align: center"><span style="color: rgb(33, 89, 103)"><strong>理赔简记</strong></span></section></section></section></section></section></span></section><p ><br /></p><ul ><li style="color: rgb(33, 89, 103)"><p ><strong>被保人：</strong>郭先生孩子</p></li><li style="color: rgb(33, 89, 103)"><p ><strong>投保险种：</strong>华泰健康宝宝少儿门急诊险</p></li><li style="color: rgb(33, 89, 103)"><p ><strong>投保时间：</strong>2021年1月</p></li><li style="color: rgb(33, 89, 103)"><p ><strong>出险原因：</strong>腺样体肥大</p></li><li style="color: rgb(33, 89, 103)"><p ><strong><span >出险时间：</span></strong><span >2021年6月</span></p></li><li style="color: rgb(33, 89, 103)"><p ><strong>获赔金额：</strong><span >5172.01</span>元<strong><strong ></strong></strong></p><p ><br /></p></li></ul><section ><section ><section ><section ><section ><section ><span ><section ><section style="text-align: left"><section ><section style="color: rgb(50, 135, 156)"><section style="text-align: center"><span style="color: rgb(33, 89, 103)"><strong>理赔回顾</strong></span></section></section></section></section></section></span></section></section></section></section></section></section><p ><br /></p><p ><span >郭先生家有两娃，</span><span >今年1月在【懂保爷】平台了解后，</span></p><p ><span ><br /></span></p><p ><span >自己主动给孩子买了一份非常适合儿童投保的小额医疗险—</span><strong >华泰健康宝宝少儿门急诊险。</strong></p><p ><span ><br /></span></p><p ><span >同时包含<strong>门（急）诊</strong>+<strong>住院</strong>责任，门诊免赔额仅有100元，住院更是0免赔。<br /></span></p><p ><span ><br /></span></p><p ><span >还可以线上理赔，非常便捷。<br /></span></p><p ><span ><br /></span></p><p ><span >上月孩子因病入院，后确诊为<strong>腺样体肥大</strong>。</span></p><p ><span ><br /></span></p><section style="text-align: center"><img src="/api/reviews/image?src=https%3A%2F%2Fmmbiz.qpic.cn%2Fmmbiz_png%2FaqibLpHUEczumlIjBLZrue85Zs0n2A3zNfRtibQbm2B1IQSazL3eMticZruaLaTSCuBHibm4riajDTGglBedrv0yopg%2F640%3Fwx_fmt%3Dpng" data-origin="https://mmbiz.qpic.cn/mmbiz_png/aqibLpHUEczumlIjBLZrue85Zs0n2A3zNfRtibQbm2B1IQSazL3eMticZruaLaTSCuBHibm4riajDTGglBedrv0yopg/640?wx_fmt=png" alt="懂保爷测评配图" loading="lazy" /></section><p ><span ><br /></span></p><p ><span >累计花费8317.07元，扣除统筹2570.39元后，</span></p><p ><span ><br /></span></p><p ><span >社保统筹结算按100%应赔付5746.68元。</span></p><p ><span ><br /></span></p><section style="text-align: center"><span ><img src="/api/reviews/image?src=https%3A%2F%2Fmmbiz.qpic.cn%2Fmmbiz_png%2FaqibLpHUEczumlIjBLZrue85Zs0n2A3zNGmWAHKLZbYhbwT43p3iaHvvjApquTWtcNU6NEH6IEaqjriaic3gYblrDw%2F640%3Fwx_fmt%3Dpng" data-origin="https://mmbiz.qpic.cn/mmbiz_png/aqibLpHUEczumlIjBLZrue85Zs0n2A3zNGmWAHKLZbYhbwT43p3iaHvvjApquTWtcNU6NEH6IEaqjriaic3gYblrDw/640?wx_fmt=png" alt="懂保爷测评配图" loading="lazy" /></span></section><p ><span ><br /></span></p><p ><span >应赔<span >5746.68元，为啥最终只赔了<span >5172.01元</span>呢？</span></span></p><p ><span ><br /></span></p><section ><span >大家可能看到一句话：</span></section><p ><br /></p><section ><span >“由于投保前<strong>已有打鼾症状</strong>，与客户协商后按照应赔付金额的90%赔付5172.01元。”</span></section><p><br /></p><p ><span >这是因为郭先生事先未就孩子健康情况咨询平台老师，便自己为孩子投保了。</span></p><p ><br /></p><p ><span style="color: rgb(136, 136, 136)">这里告诫大家：我们投保时不要自己认为“健康”就直接投保，一定要跟老师沟通给出意见后，再进行投保。</span></p><p ><span ><br /></span></p><p ><span >后果便是，上月孩子生病后申请理赔，被保险公司认为<strong>事先已有症状</strong>，<strong>作为既往症不予理赔</strong>。</span></p><p ><br /></p><p ><span >但这个结果不仅郭先生难以接受，我们也不能接受。</span><br /></p><p ><br /></p><section style="text-align: center"><img src="/api/reviews/image?src=https%3A%2F%2Fmmbiz.qpic.cn%2Fmmbiz_jpg%2FaqibLpHUEczt3ATArPQXZYxhV44tB5khPtVny66icGEfuYONN3Tt6YHeqicU0mrx9FHVb5fsyecKkmibiaOdHwOzBng%2F640%3Fwx_fmt%3Djpeg" data-origin="https://mmbiz.qpic.cn/mmbiz_jpg/aqibLpHUEczt3ATArPQXZYxhV44tB5khPtVny66icGEfuYONN3Tt6YHeqicU0mrx9FHVb5fsyecKkmibiaOdHwOzBng/640?wx_fmt=jpeg" alt="懂保爷测评配图" loading="lazy" /></section><p ><br /></p><p ><span >后经平台老师等多方长时间沟通协商下，保险公司最终将<strong>拒赔</strong>改为<strong>报销90%</strong>，事情得以解决。</span><br /></p><p ><span ><br /></span></p><p ><span >再次提醒大家，保险医学和临床医学有一定差异，投保前一定要咨询专业人士。<br /></span></p><p ><span ><br /></span></p><p ><span >否则容易造成我们觉得明明没问题，为什么保险公司拒赔的问题。<br /></span></p><p ><span ><br /></span></p><p ><span >对待保险的健康告知，我们一定要慎重！</span></p><p ><br /></p><p ><span style="color: rgb(136, 136, 136)">注意：在「懂保爷」公众号投保的朋友，可以选择联系公众号的协赔专员，再向保险公司报案，我们会全程提供理赔协助：</span></p><p ><br /></p><p style="text-align: center"><img src="/api/reviews/image?src=https%3A%2F%2Fmmbiz.qpic.cn%2Fmmbiz_png%2FaqibLpHUEcztJ2AJwfjmibWITsubs4Y23WbzgJHESD2qDKM9fycMKInuice3tqUvuBHb7nful1paDQY0aQ83P0htw%2F640%3Fwx_fmt%3Dpng" data-origin="https://mmbiz.qpic.cn/mmbiz_png/aqibLpHUEcztJ2AJwfjmibWITsubs4Y23WbzgJHESD2qDKM9fycMKInuice3tqUvuBHb7nful1paDQY0aQ83P0htw/640?wx_fmt=png" alt="懂保爷测评配图" loading="lazy" /></p><p ><span ><br /></span></p><p ><span >当然，今天的案例也佐证了：</span></p><p ><span ><br /></span></p><p ><strong><span >孩子在配置终身重疾险后，最应该买的是小额医疗险，而不是百万医疗险！</span></strong></p><section ><br /></section><section ><span >尤其孩子容易感冒发烧、肺炎支气管炎啥的，去一次医院，买小额医疗险的几百块保费就“收回”了。</span></section><section ><br /></section><section ><span style="color: rgb(136, 136, 136)">而正常百万医疗险“起付线”高达1万，能住院花1万的病，重疾险有90%的可能用到了。</span></section><section ><br /></section><section ><span style="color: rgb(136, 136, 136)">即便真没用到，正常小额医疗险能报销2-10万，这个保额基本覆盖重疾险之下的所有疾病了。</span></section><section ><br /></section><section ><span >所以孩子有<strong >终身重疾险+小额医疗险</strong>就够了，真有钱再去考虑百万医疗险，作为这二者的补充。</span></section><section ><br /></section><section ><span >真别觉得给孩子买个百万医疗险就行了，一点不靠谱！</span></section><p ><span ><br /></span><span style="color: rgb(136, 136, 136)">具体建议家长们看看：</span><a target="_blank" href="http://mp.weixin.qq.com/s?__biz=MjM5MjY4MjU0MQ==&mid=2447794031&idx=1&sn=b76de391ba7cd51ab6cf93215c71bb55&chksm=b2b0782d85c7f13bc87bf9715446363a0f928dfa7a56e00f6685b19a22a30dff1c705fabcab1&scene=21#wechat_redirect" tab="innerlink" ><span >别无脑买百万医疗险了，没你想的那么重要！</span></a></p><p ><span ><br /></span></p><p ><span >希望大家别被误导了。</span></p><p ><span ><br /></span></p><p ><span style="color: rgb(136, 136, 136)">我们下期再见~</span></p><p ><span style="color: rgb(136, 136, 136)"><br /></span></p><section ><span style="color: rgb(0, 0, 0)"><span style="color: rgb(33, 89, 103)">在【懂保爷】投保过的朋友要是出险，可以点击</span><strong style="color: rgb(33, 89, 103)">公众号右下角「我的服务」-「理赔协助」</strong><span style="color: rgb(33, 89, 103)">联系协赔专员申请协助。</span></span></section><section ><span style="color: rgb(33, 89, 103)"><br /></span></section><section ><br /></section><section style="text-align: center"><span ><span >— </span><strong >END </strong><span >—</span></span></section><section style="text-align: center"><span style="color: rgb(0, 0, 0)"><strong >愿你家的保单永不出险！</strong></span></section><section style="text-align: center"><br /></section><section style="text-align: center"><img src="/api/reviews/image?src=https%3A%2F%2Fmmbiz.qpic.cn%2Fmmbiz_gif%2FaqibLpHUEcztskunFytwCia8wiaepDysSMfE3VwhSiaK8siaOT9TuTk1zdwnnNQxrWZ5P8bwZP6icia0z7fyVElB7hctw%2F640%3Fwx_fmt%3Dgif" data-origin="https://mmbiz.qpic.cn/mmbiz_gif/aqibLpHUEcztskunFytwCia8wiaepDysSMfE3VwhSiaK8siaOT9TuTk1zdwnnNQxrWZ5P8bwZP6icia0z7fyVElB7hctw/640?wx_fmt=gif" alt="懂保爷测评配图" loading="lazy" /></section><section style="text-align: center"><br /></section><section style="text-align: left"><img src="/api/reviews/image?src=https%3A%2F%2Fmmbiz.qpic.cn%2Fmmbiz_gif%2FAa1Vn4VNXulDSG3kLWEFl66JYfFHuibDsZwPP3g5romOwOBrEvLdFjc8VUrEoXpQflzzTumnt8dW6vKFReAyKnA%2F640%3Fwx_fmt%3Dgif" data-origin="https://mmbiz.qpic.cn/mmbiz_gif/Aa1Vn4VNXulDSG3kLWEFl66JYfFHuibDsZwPP3g5romOwOBrEvLdFjc8VUrEoXpQflzzTumnt8dW6vKFReAyKnA/640?wx_fmt=gif" alt="懂保爷测评配图" loading="lazy" /><span > <span style="color: rgb(136, 136, 136)">点击阅读原文，查看</span><span style="color: rgb(33, 89, 103)">懂保爷精选保险</span></span></section><section ><section ><br /></section><section style="text-align: right"><section ><p style="text-align: center; color: rgb(63, 62, 63)"><span >如有帮助，帮忙点个<span style="color: rgb(33, 89, 103)"><strong>在看</strong></span></span><span style="color: rgb(0, 0, 0)">吧</span><span >，谢谢！</span></p></section></section></section>
