Medical insurance in India is based on falsehoods, argues a prominent liver transplant surgeon, urges insurance companies to get real. A view from the other side
Mr Ray is 53, he has been a diabetic for 5 years. Recently, he suffered from a urine infection and he insisted that he gets admitted for treatment. He was sure that his medical insurance policy with a cover of 10 lakhs will be sufficient for covering all the expenses. He was also aware that he had never declared diabetes as a pre existing illness at the time of starting the policy.
So, he insisted upon the consultant physician that the word diabetes never be mentioned in the medical records and discharge summary, else his claim to the insurance company will be turned down.
The physician was all too familiar with such requests and he obliged.
– As a result, the insurance company disbursed the claim but Mr Ray is a non diabetic on record.
– Such falsehoods are aplenty in the medical insurance sector in India.
Ask any liver physician, and he can give countless examples of such requests. As alcohol is considered to be an untouchable with regard to medical insurance, most insurance companies refuse claims where alcohol is mentioned remotely in the summary.
If insurance companies include and quantify alcohol consumption and determine the premium amount proportionately, much of such falsehood can be avoided. Insurance company agents can be tutored to encourage people to declare preexisting illnesses
This results in repeated requests to treating physicians to not mention alcohol in the history of a patient’s illness. A single admission can set a person with advanced liver disease back by as much as 2 to 3 lakh rupees and such admissions become frequent as the disease progresses over time. Liver transplantation is an entirely different ball game, most transplants in India cost between 20 to 30 lakh rupees and rarely do insurance companies reimburse the amount in full.
Hence, falsehood abounds. Alcohol is not mentioned in patient history. The physician’s counter argument is that most patients will never be able to afford treatment with out of pocket expenses. Same holds true for smoking. Countless requests are made to physicians to omit the words ‘smoking and alcohol’ and many physicians oblige.
The malaise lies in the ridiculous policy of the insurance companies–clauses like no coverage for 1/2/3 or 4years for pre existing illness. Policy regarding smoking and alcohol. Not everyone who consumes alcohol is an alcoholic, but the mere mention of the word is sufficient to refute claims.
If any public health researcher ever studies liver disease from medical insurance records–he will find alcohol as a non existent cause when the reality is different. Such falsehood can be avoided with transparency and fair insurance policies.Only a minority of insurance policies cover pre existing illness from day one.
If insurance companies include and quantify alcohol consumption and determine the premium amount proportionately, much of such falsehood can be avoided. Insurance company agents can be tutored to encourage people to declare preexisting illnesses and reassure clients that the enhanced premium for such declaration will ultimately be of benefit to the client. The falsehood on which medical insurance is based in India can be avoided.
