The fine print in your health insurance policy might not be right for you

They say there are lies, fucking lies, and statistics. Likewise, is there a sharp practice, sharper practice, and health insurance?

The question came to mind when I recently had to undergo minor but necessary surgery that required a one-day hospitalization.

As India’s remarkably effective counter-offensive against the pandemic has proven, our healthcare professionals, from doctors to other healthcare workers, are among the best and most dedicated in the world and deserve all praise. The same is true for many, if not most, of our hospitals and other health centres.

The fly in the ointment, or in the prescription, is found in health insurance policies.

I have been insured with the same company for over 25 years and over time I have earned a bonus of Rs 1,60,000 on my Rs 4L cover. Yet, when the cashless pre-approval of my hospitalization was granted, it only cost Rs 42,500, for a procedure that usually costs between Rs 65,000 and Rs 1,50,000.

Regardless of my condition requiring surgery, the shock of the gap between the insurance payable and the expected cost of the procedure sent my blood pressure soaring. Subsequent investigation revealed that it is “common practice” to pre-approve only 25-50% of the estimated cost of treatment, with final payment made after the insurance company’s hawk-eyed calculators identify so many unclaimable items. as possible, the bill that the patient has to pay.

These items are called “Consumables”. I thought the word referred to what I would consume as food during the one day cure.

But no. According to health insurers, “consumables” include ultrasound tests, “analysis”, as well as bandages, plasters, hypodermic syringes and all other paraphernalia related to surgery.

I was grateful to note that the “Consumables” did not include the air I breathed during the treatment. But I felt like charging for bandages etc. for surgery as unclaimable “consumables” was like asking a cook to prepare a meal without the benefit of pots, pans and other kitchen equipment.

My procedure went smoothly and with minimal stitches. But perhaps our medical insurance calls for a caveat: this health insurance could harm your financial health.



The opinions expressed above are those of the author.