Short Settlement is a Big problem with Health Insurance

Hello and Namaste Everyone,

Insurance is something that most of us try to have but it is not just one thing. I mean to say there are various types of insurance, such as life insurance, health insurance, and general insurance, covering many other things, including the vehicle and home, etc. After the pandemic, the health insurance plan is highly recommended because the hospitalization cost has increased. It is difficult to manage finances when something wrong happens with our health and we get hospitalized. Hospitals are charging a lot and it can be difficult for any middle-class person to manage the expenses so it's better to have health insurance in place to avoid this sudden expense.

Last week my son was not doing well so we had to admit him to the hospital. He had a fever and also had abdominal pain. We didn't know why it was happening so admitting to the hospital was the best option. After the test, he was diagnosed with dengue fever and for that reason, he had to stay there for 2 days. The recovery time is more than a week but if there are problems then it's good to stay in the hospital. After one day he was feeling better so on the second day doctors advised him to discharge him because there were several problems and he was in a better situation. Although the medication is still on there are some precautions which are suggested by the doctors and he is taking care of it.

I have health insurance and during the admission, I informed the hospital about the medical plan. In India even if you have a medical plan then also you will have to pay some deposits upfront. I paid the deposit and the treatment that started and at the same time, they also notified my insurance company about the hospitalization. The insurance company took one day to provide the initial approval for the treatment but it was started since I already paid an amount up front. The hospital I visited was the network hospital of the insurance company. It's always recommended to go for the network hospital for cashless or better settlement because if we visit non-network hospitals then sometimes there can be a lot of issues with the bill settlement.

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I was expecting that the entire will be settled by the insurance company but I was shocked when the final bill came after two days. The insurance company settled only 80% of the bill amount and for the remaining twenty percent they have provided different remarks. I'm not from the hospital background and I don't understand what are these exclusions. They have mentioned a lot of things on the settlement later which I'm still trying to figure out. IIt'sbeen a couple of days but I don't know whether I should question them or not and I am still trying to figure out more information over the Internet. I also tried to find somebody in my relation or the neighborhood who belongs to the insurance or hospital industry and can guide me but till now no luck with this. I will try my best to figure out some solution so that I can also claim the remaining 20% that has not been paid by the insurance company. In this situation, I was left with no other option than to pay the remaining amount from my pocket and get the discharge so I did it.

I did some research on the Internet that why these insurance companies try to short-settle insurance claims. I was shocked to see that there are so many people who have complained about the same problem and there is a reason why these insurance companies follow the strategy of short settlement. It's because if they reject the entire bill then the person will drag him to the court and in that case, they will have to go through the legal process. If they approve the claim with a partial amount with some stupid questions and logic then in most of the cases person will not be able to question them. Because not everyone is aware of what could be the clause and maybe they are not aware of it the insurance companies might be right and because of this they are taking advantage of this situation. It is obvious that what they are deducting every time is not always right and I'm sure that in my case also the deductions are unfair. Maybe not the entire amount but surely more than fifty percent is an unfair deduction and I'm not happy with it.

So I realized that the short settlement is one of the biggest problems in India with health insurance and we need to be careful. Unfortunately is not much in the handout you just like me because we don't know the technical terminologies and rules for dealing with health insurance and the way they operate. I don't know if I'll be able to find the solution and I can claim for the remaining amount. It takes a couple of days to get settled after the hospital discharge because it was a tough time and now I'm trying to spend some time over the Internet to find some solutions. I'm sure that there should be something that can help me out but till now I have no clarity but looking at the overall scenario and this problem I can say that it is such a big problem and people need more awareness and information to deal with this scam that health insurance companies are doing with innocent customers.

Thank you so much
Stay Safe

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