A recent controversy has reignited public outrage over the glaring disparities in the medical insurance industry. Insurance companies, while marketing their policies, promise extensive benefits to unsuspecting customers. However, when it comes to fulfilling claims during emergencies, these promises often vanish under a cloud of technicalities and fine print. Middle-class policyholders, in particular, bear the brunt, facing unreasonable rejections and hefty premiums.
On the other hand, celebrities and influential figures seem to receive preferential treatment. This discrepancy was spotlighted recently when documents related to actor Saif Ali Khan’s health insurance claim were leaked on the social media platform X. The actor had filed a claim of ₹35.95 lakh with Niva Bupa Health Insurance for his treatment expenses. While the insurer approved ₹25 lakh, the hospital bill was eventually settled at ₹26 lakh. This raised questions about the swift handling of celebrity claims compared to the cumbersome processes faced by the average citizen.
Dr. Prashant Mishra, a cardiac surgeon at Tunga Hospital, criticized the industry’s approach, noting, “Celebrities and luxury hospitals receive significant leniency, while smaller hospitals struggle to secure approvals beyond ₹5 lakh.” He also warned that such practices contribute to rising premiums, further burdening middle-class policyholders.
Real-life experiences underscore these inconsistencies. Mahesh Seth, whose wife underwent hip and knee surgeries, shared how he had to pay ₹4 lakh upfront since the hospital was outside the insurer’s network. Though he was eventually reimbursed ₹3.88 lakh, certain expenses were deemed ineligible for reimbursement. Similarly, Kiran Karkera, a 28-year-old, recounted the arduous process of navigating claims for his spine surgery, despite having an additional top-up policy.
Another case involved a Goregaon resident whose claim for ₹15,000 following an endoscopy was rejected because it was classified as an OPD procedure. Insurance consultant Mahavir Chopra pointed out that cashless insurance policies often fail during emergencies, forcing policyholders to make immediate payments out of pocket and bear temporary financial stress.
The insurance industry’s spokespersons have defended their processes, with a representative from Niva Bupa Health Insurance explaining that claim amounts depend on factors like hospital type, location, and severity of the condition. Customers must adhere to specific claim procedures, whether for cashless benefits or reimbursements, to ensure smooth processing.
A well-known individual from Sikkim, a policyholder of Care Insurance (Care Health), shared his frustration, stating, “Over the past two years, I’ve paid premiums amounting to ₹45,000. However, last month, when I approached Policy Bazaar to file a claim, this so-called reputable company refused to reimburse me, citing vague rules and unclear criteria. I truly believe they are exploiting innocent policyholders. It’s deeply disheartening to see such dubious practices openly targeting average people.”
There are still countless innocent policyholders who continue to suffer in silence, paying their premiums year after year. Health is such a vital aspect of life that many feel they have no choice but to comply, fearing the consequences of being uninsured. However, the situation has now reached a breaking point, and it’s time for everyone to recognize the truth before more unsuspecting individuals fall victim to these medical insurance agents and companies.
Their glossy whitepapers and promises often crumble when faced with real-life situations, revealing the stark reality of deceit and exploitation. “They are cheating us, and it’s absolutely true,” says an aggrieved policyholder from Sikkim, sharing his experience. The alarming discrepancy between what is promised and what is delivered is something no one can ignore any longer. It’s a wake-up call for all to scrutinize the industry before more innocent lives are impacted.
This ongoing debate sheds light on the monopolistic tendencies within the medical insurance sector, where ordinary policyholders seem to be caught in a web of high premiums, rejected claims, and opaque processes. Meanwhile, influential customers face fewer hurdles, perpetuating an inequitable system.
