(31 Mar ’07)
It was time, I thought,
considering the cost of medical treatment these days, I had an insurance policy
for it. The Oriental Insurance company gave me a form (the staff there is
polite and helpful) and told me I couldn’t do the prerequisite tests in any
large hospital but in the seedy ones listed in their brochure. I wanted to take
along my own disposable needles, after I saw the list. Well, the ‘pre-policy
health check’ itself was ok, the staff there, too, was warm and concerned and I
was offered a small breakfast as I’d gone fasting overnight. The place
(Poonamiya Hospital, Dadar) was pleasantly clean. However, what irked me at the
end wasn’t the medical part but the opacity of the procedure between them and
the insurance company. I paid for a blood test, an x-ray, an ultra-sonography
and a physician’s examination. I got no report(s). I was told that the original
report was to go to the Insurance company. Fair enough. Could I have a photo
copy or a duplicate so I know the baseline of my health status today? No. I
would pay extra for them. No.
If the Insurance company doesn’t
want me to have the reports, it should have paid for them. Also, in spite of
being examined, I’ve no idea whether I have diabetes or fibroids or lung
cancer. Subsequently, if I were to be hospitalized for something, the insurance
company will turn around and say, “look, but you had it in you.” How’d I know?
The company and the hospital have treated my health like their secret. What was
explained to me was: if a particular item is excluded, that means the report
concerning that illness or part of body was not ‘normal’. To what extent? The
client will not know unless (s)he does another check at his/her own cost.
I know that most people
who are covered by a ‘cashless’ policy imagine that they have to spend nothing
at all if and when they’re hospitalized. Agents, at least mine, gets his
commission by receiving my cheque once a year for renewal of policy. When I
needed him desperately during my husband’s emergency admission, he said he
couldn’t do anything for me. Big deal. Back to the cashless insurance: when a
person wants to get admitted to a hospital, he has to send a prescribed form to
the Third Party Assurers (TPAs). When they authorize the hospital to treat the
case as ‘cashless’ upto a certain amount, only then is it so. Until then, the
patient/family has to pay the dues.
For those who need to
get their bills reimbursed, there are other obstacles. I have no doubt things
have improved and are further improving, but unless the process is clear and
transparent, regular quarrels with the company, hospitals, are going to remain
the norm. A doctor colleague told me that doctors employed by insurance
companies are encouraged to reject claims. This, in all fairness, is because
the medical fraternity has become criminally greedy about getting money easily
from the insurers. But we mustn’t forget that the customer’s interest is what
has to be protected. Screen the applications, by all means, but when a denial
comes through, there should be no ambiguity at all. Presently, no clear reasons
are offered to the customer at any stage.
I certainly wasn’t
offered any explanation as to why I couldn’t get my reports in spite of having
paid for them.
With private players
coming into the fray with easier rules, this will change. Perhaps slowly.
Unless all who have policies question and protest, that change won’t be as
rapidly as desired.
I know a lot of people
who prefer to invest the premium and keep a separate ‘kitty’ for medical
emergencies rather than take an insurance policy. Because far too many people
have been taken for a ride.
If the insurers are
serious about long term business, they will have to make their rules
user-friendly and fair.
@@@@@
No comments:
Post a Comment