Disputes between health insurance companies and patients rise during second wave

Aurangabad, July 23:

Many people are unaware that materials like expensive and new medicines, disposables and PPE kits are excluded from health insurance. Therefore, in the second wave several cases were reported where the patient had to pay Rs 1 lakh to 1.5 lakh out of his pocket despite having an health insurance policy of Rs 5 to Rs 10 lakh due to hidden terms and conditions from the insurance companies. This led to disputes between the hospitals and the relatives, said president of the Marathwada hospital association and administrator of the Seth Nandlal Dhoot hospital Dr Himanshu Gupta.

Dr. Gupta said that the relatives are informed if less insurance amount is approved rather than of the given quotation of treatment cost. Often the quotation is of Rs 50,000. However, insurance companies approve expenses of Rs 20,000 to Rs 30,000. When a patient is discharged after completion of treatment, the insurance amount is approved. But the insurance company never approves the complete amount as per the terms. Relatives have to pay the remaining bills. The insurance policy provides one per cent for room rent. In addition, the insurance company tries to add fees for doctors, nursing and other services. However, in reality the hospital charges are higher. This leads to disputes between the patient and the hospital. Misconceptions are created about the hospital. Therefore, when taking a policy, one should first understand what expenses will be incurred and what will have to be paid.

Reasons for reduction in insurance amount

The insurance company claims to pay the full treatment cost when selling the policy. However, a closer look at the terms and conditions of the policy reveals that many things are not paid for by insurance companies. Therefore, the difference in the quotation of treatment, approval, sanction of insurance amount is the cause of argument in the hospital. While taking insurance, patients have cashless and cost reimbursement options. Everyone tries to get cashless insurance. However, that is not the case. This is because the insurance companies affiliation with the hospital pays up to 1 per cent of the sum insured as per the terms and conditions.