After surviving Covid-19, it’s now a fight to get medical insurance claims

As if preventing Covid-19 was not sufficient, many households throughout the nation are now engulfed in a battle with their insurance firms and repaying loans for the exorbitant payments of their therapy. The complaints in opposition to the medical insurance firms are mounting.

India Today reviews about a few of the affected households who’re battling their payments and are at odds with the insurance firms throughout the nation.

Maharashtra: ‘Insurance Company Looting People’

Pooja Tiwari, a resident of Balaji Nagar in Maharashtra’s Akola, examined optimistic in October 2020 and had to be admitted to Hotel Regency Covid-19 Care Hospital within the metropolis. Soon, her husband and daughter additionally examined optimistic.

The medical invoice, which included blood reviews, Remdesivir vials and keep fees amongst different medical bills, got here down to Rs 2.84 lakh.

Just when she thought that her insurance firm would come to her rescue, Pooja was left upset when the corporate solely lined the bills price Rs 11,000.

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“The insurance companies are here only to loot people. We had such a hard time. Our shop was closed, there was no income either and on top of our sufferings, the system failed us,” Pooja instructed India Today.

After a lot deliberation, Pooja sued the corporate and despatched a courtroom discover. The insurance firm then additional settled the declare of an extra Rs 8,000.

Uttar Pradesh: Covid-19 Battle Won, Lost Financial Stability

Greater Noida’s resident Sanjeev Saxena additionally discovered himself in a comparable state of affairs when his spouse was hospitalised after testing optimistic for Covid-19.

At the final minute when he bought no assist from the mediclaim coverage, he had to take a bank card mortgage to pay the payments. His spouse had to be admitted to a non-public hospital in May and was placed on oxygen help and had to keep within the ICU for 15 days.

“When the wife was on oxygen support, I didn’t want to fight with any health insurance company,” Saxena mentioned.

His spouse received the battle in opposition to Covid-19 however Saxena’s monetary situation deteriorated due to Rs 6 lakh price payments and insurance firm’s indifference. The firm has neither paid the invoice underneath the cashless scheme extra has given any refund.

Sudhir Aggarwal (60), a resident of Firozabad, Uttar Pradesh, was contaminated with the coronavirus in December 2020. He acquired therapy at a well-liked non-public hospital in Gurgaon. When he got here again after recovering, he claimed insurance for the fee of his invoice of Rs 2.5 lakh from a non-public life insurance firm.

READ: The long Covid tale: If you are recovering from coronavirus, this is normal

But the insurance firm neither paid any declare nor gave any passable reply. Aggarwal himself paid the invoice for the hospital.

According to him, he had taken this coverage on March 31, 2018, for which he has been paying premium constantly. Even until the 12 months 2021, he deposited the premium.

“I first got treatment in Firozabad’s MC Agarwal Hospital, they told me that your condition is bad, there is a problem in your lungs. You should visit a good hospital. I rushed to the hospital in Gurgaon. There I was put on oxygen and after 10 days I was discharged,” he instructed India Today.

“I had applied for the medical claim, filled the form, I also gave them the papers. They have not given any reply till date even though I have submitted the claim. I have given all the documents,” he added.

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Neeraj Aggarwal from Aligarh also faced a similar situation. He and his wife had tested positive, and both were hospitalised. While the wife could not survive, he was treated for Covid-19 in Noida at a private hospital.

When he sent his bill to the insurance company after recovering, the company covered only 20-30 per cent of the total bill of Rs 2.75 lakh. He had taken his medical policy from Star Health.

“When we sent our servant to collect the claim, the company people finalised Rs 71,350 and sent it. After that, we sent many reminders to the company, made many rounds but we have not been given the full amount yet,” Neeraj said.

“My wife died, she had a policy of another company, for which we got full money but Star Health has bothered us a lot,” he added.

Rajasthan: ‘Hospitals Not Considering Govt Insurance’

In Rajasthan, the government has claimed that Covid-19 and black fungus will be treated for free under the Chiranjivi Yojana. Despite that people have been in debt due to the disease and the high cost of treatment.

Hansraj Panchal from Bund district’s Lesarda tested positive and died due to black fungus. After he tested positive, Panchal was referred to a private hospital in Jaipur, where the bill had come down to Rs 7 lakh.

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The family was already in debt and was not able to pay for the private hospital facilities. Panchal was then transferred to a government hospital, where he breathed his last.

Panchal’s father told India Today, “He is survived by two children. We will have to sell the house to repay the loan.”

“The government is saying that Covid-19 and black fungus will be treated if you have government health insurance but despite that nobody is considering it,” Panchal’s brother said.

Madhya Pradesh: Insurance Company MIA, Patient Still Stuck Paying Premiums

Rahul Sharma, a resident of Khandwa city, was tested positive on April 25, and was in home isolation. But after his situation got worse, his family rushed him to a private hospital, which was also a Covid centre in the city on April 30.

The doctors at the hospital conducted a HRTC scan, it showed that his oxygen level was going down and 28% lung infection.

He was admitted to the hospital the same day. Rahul told India Today that he has informed his insurance company about his situation on May 1 and the company asked him to send the bills and hospital discharge receipt. Rahul said that bills and documents were sent to the company on their app.

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The bill was worth Rs 80,000, including the treatment, hospital room rent, multiple tests and medicines. But Rahul said that despite repeated attempts, the company has not addressed the mediclaim nor has paid the money. “This is not a small amount for me as I am not doing any job these days and I have taken a gold loan to pay the hospital bills,” said Rahul.

He also claimed that he had to pay monthly interest on his gold loan now for the second month. Rahul is now thinking to go to consumer court as he feels cheated and has no other option left.

Insurance Agents’ Argument

Amit Kumar Pandey, who is a medical insurance agent for Star Health and Allied Insurance Company in Varanasi, said that all his clients suffered the same fate. He told India Today that despite having a cashless facility, during that time no hospital was ready to treat Covid-19 patients on cashless mode of payment.

“Therefore, the insured people were getting admitted in the hospitals by paying cash, thinking of getting the money reimbursed from the insurance company.”

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Although experts have said that insurance companies cannot reject the claims, people need to be aware of the procedures and need to have proper documentation in place.

Ashish Jhamb, Director and COO of Infina Insurance Broking, told India Today, “There are well-defined guidelines, so an insurance firm can’t say no to a Covid-19 claim. People need to be aware and have proper documents.”

“The problem is with the hospitals who do not inform the patients properly and don’t guide them properly,” he added.

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