The nearly 70 percent sanctioned amount of the Rs 35.95 lakh medical bill for actor Saif Ali Khan’s treatment at Lilavati Hospital has reignited debates about exorbitant healthcare costs and insurance policies in India.
Influencer Revant Himatsingka, popularly known as Food Pharmer, shed light on the hidden practices of the health insurance industry that leads to cancellation or partial pay of 50 percent of the claims.
In a post on X (formally Twitter), wrote, “2 weeks ago, I launched ‘Terms and Conditions Samjhega India Campaign’ to educate Indians about misleading claims by various industries. I asked everyone to vote which industry I should start with, and over 80% of people voted for health insurance.”
In the follow-up posts Himatsingka highlighted the clauses, blacklisted hospitals and exclusions that leads to rejected claims along with their possible solutions.
As per the post, here are top 3 such factors behind rejection of claims:
PROBLEM: Reasonable and Customary Clause
Insurers may use this rule to pay a portion of your hospital bill. For example, assume a cataract operation costs Rs 790k at a hospital. However, the insurer covers only Rs 60k, claiming this is the reasonable limit for such a treatment.
SOLUTION: Request a detailed explanation from the health. insurance company. If they can’t provide an explanation, make an official complaint to the grievance cell.
PROBLEM: Blacklisted Hospitals
Insurance doesn’t cover treatments from certain hospitals due to past issues like billing disagreements.
SOLUTION: Find out in advance which hospitals might be blacklisted by your health insurance policy.
In case of emergency, if you end up going to a blacklisted hospital, ask to be transferred to an in-network hospital after your health becomes stable.
PROBLEM: Permanent Exclusions
There are some health conditions and treatments that are NEVER covered. These include:
* Conditions caused by alcohol or drug use.
* Unproven treatments
* Cosmetic procedures that are only for aesthetic enhancement
SOLUTION: Consult a CERTIFIED advisor, who can explain your policy before you choose one, including what treatments are covered and not covered.
Himatsingka, popularly known as the ‘Food Pharmer’ is a certified health coach, who is on a mission to improve health literacy in India by educating people on the importance of reading food labels. His efforts have garnered over two million followers on social media.