Bengaluru: While the nation celebrated Independence Day, August 15 last year, a city resident. Rajath Hari was having trouble claiming insurance to pay for his mother’s stay in hospital as it was a holiday.
"My mother was discharged from hospital on August 15 last year and as the insurance company didn't work that day we paid the charges , hoping to later claim them," he recounted. But to his shock, the company refused to compensate the family , saying various aspects of the hospital stay were not covered by the policy.
His story is not uncommon as others too have had various harrowing experiences with health insurance companies of late. Said one tired relative of a patient who was admitted to a private hospital.
"My sister had to stay a day more in hospital despite the doctor saying she was absolutely fine and could go home only because we had trouble with the insurance company. We finally gave in and paid the charges to take her home."
Another Bengalurean claims he was fooled into opting for a health ins-urance policy. "I wrote a cheque of Rs 2.82 lakh as premium for my health insurance as the company representative failed to inform me that I could not make any claim for two years. I learnt of this only after I received the hard copy of the documents on the tenth day of writing the cheque and read the fine print," said Rear Admiral BR Vasanth( retd), who challenged the insurance company in court and got the premium he had paid.
"Health insurance has long been a mysterious entity for consumers. We expect companies to come and pay all our medical bills without question,but the insurers look at all claims with suspicion," said Dr Neelesh Bhandari, founder, Healtho5 Solutions.
Agreeing that patients often have a harrowing time, Dr Gautam Kodikal, Senior Consultant Orthopaedic Surgeon, Apollo Spectra Hospitals, said, "Most of the time the companies insist that the patients need to stay for at least 24 hours to claim insurance. Such a protocol only adds to their inconvenience and hospital beds are occupied when they don’t need to be. We , however, insisted that the whole process does not help anyone and now they have agreed to accept claims even if the patients is out after four hours."
Observing that the way insurance companies operate leads to unnecessary stays in hospitals, more surgeries and more investigations, Dr Thelma Narayan,Director of Society for Community Health Awareness Research and Action (SOCHARA), believes there needs to be a strong regulatory body and better ethics to regulate the insurance sector.
