Bitter medicine: The fine print on your health insurance policy might not be so fine for you - Times of India

It’s said, there are lies, damn lies, and statistics. Similarly, is there sharp practice, sharper practice, and health insurance?

The question was brought home to me when I recently had to undergo a minor, but necessary, surgical procedure which required hospitalisation for a day.

As India’s remarkably effective counteroffensive against the pandemic has proved, our medical professionals, from doctors to other healthcare workers, are among the best and most dedicated in the world and deserve all praise. So do many, if not most, of our hospitals and other health centres.

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

I have been insured by the same company for over 25 years and, over time, have earned a no-claim bonus of Rs 1,60,000 on my Rs 4L cover. Yet when the cashless pre-approval for my hospitalisation came through it was for only Rs 42,500, for a procedure which typically costs between Rs 65,000 and Rs 1,50,000.

Never mind my condition which required surgery, the shock of the shortfall between the insurance payable and the projected cost of the procedure sent my BP soaring. Subsequent investigation revealed that it is ‘standard practice’ to pre-approve only 25-50% of the estimated cost of treatment, the final payout being made after the hawk-eyed number crunchers of the insurance company have identified as many non-claimable items as possible, the bill for which the patient has to foot.

Such items are called ‘Consumables’. I thought that the word refers to what I would consume by way of food during the one-day course of treatment.

But no. ‘Consumables’ according to health insurers include ultrasound tests, ‘Analysis’, plus bandages, dressings, hypodermic syringes, and all the other paraphernalia attendant upon a surgical procedure.

I was grateful to note that ‘Consumables’ didn’t include the air I’d breathe during treatment. But I did feel that charging for bandages etc for surgery as non-claimable ‘Consumables’ was like asking a cook to dish out a meal without benefit of pots, pans, and other kitchen equipment.

My procedure went without glitch and with minimal stitch. But maybe our medical insurance needs a caveat: This health insurance might be injurious to your financial health.

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