As if the fight against Covid-19 wasn’t enough, many families across the country are now in a battle with their insurance companies, paying back loans for the exorbitant bills of their treatment. The number of lawsuits against the health insurance companies is increasing.
India Today reports on some of the affected families struggling with their bills and quarreling with insurance companies across the country.
Maharashtra: “Insurance companies loot people”
Pooja Tiwari, a resident of Balaji Nagar in Maharashtra’s Akola, tested positive in October 2020 and had to be admitted to the Regency Covid-19 Care Hospital in the city. Soon her husband and daughter also tested positive.
The medical bill, which included blood reports, vials of remdesivir, and subsistence expenses, among other medical expenses, came to 2.84 lakh.
Just when she thought her insurance company would come to her aid, Pooja was disappointed when the company only paid the cost of Rs 11,000.
“The insurance companies are only here to rob people. We had it so hard. Our business was closed, there was no income, and in addition to our suffering, the system let us down, ”Pooja told India Today.
After much deliberation, Pooja sued the company and sent a judicial notice. The insurance company then settled the claim for an additional Rs 8,000.
Uttar Pradesh: Covid-19 battle won, financial stability lost
Greater Noida resident Sanjeev Saxena was also in a similar situation when his wife was hospitalized after testing positive for Covid-19.
At the last minute, when he got no help from the mediclaim policy, he had to take out a credit card to pay the bills. His wife had to be admitted to a private hospital in May, received oxygen support and had to stay in intensive care for 15 days.
“When the woman was supplied with oxygen, I didn’t want to argue with any health insurance company,” says Saxena.
His wife won the fight against Covid-19, but Saxena’s financial condition deteriorated due to Rs 6 lakh worth of bills and the indifference of the insurance company. The company did not pay the bill in the cashless system or issue a refund.
Sudhir Aggarwal (60), a resident of Firozabad, Uttar Pradesh, contracted the coronavirus in December 2020. He was treated at a popular private hospital in Gurgaon. When he returned after recovering, he applied for insurance for the payment of his Rs 2.5 lakh bill from a private life insurance company.
READ: The long Covid story: If you recover from the coronavirus, that’s normal
But the insurance company neither paid a claim nor gave a satisfactory answer. Aggarwal himself paid the hospital bill.
According to his information, he had taken out this policy on March 31, 2018, for which he continuously paid a premium. He has deposited the bonus until 2021.
“I was treated for the first time at MC Agarwal Hospital in Firozabad. You told me your condition is bad, there is a problem in your lungs. You should go to a good hospital. I rushed to the hospital in Gurgaon. There I was given oxygen and after 10 days I was released, ”he told India Today.
“I submitted the medical application, filled out the form and also gave them the papers. You have not responded to this day, even though I submitted the application. I submitted 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 were both hospitalized. While the woman couldn’t survive, he was treated for Covid-19 in a private hospital in Noida.
When he sent his bill to the insurance company after his recovery, the company only covered 20-30 percent of the total bill of Rs 2.75 lakh. He had taken over his health insurance from Star Health.
“When we dispatched our servant to collect the claim, the company’s staff completed and sent 71,350 rupees. After that we sent a lot of reminders to the company, made a lot of rounds, but we haven’t received the full amount yet, ”said Neeraj.
“My wife died, she had a policy from another company that we got full money for, but Star Health bothered us very much,” he added.
Rajasthan: “Hospitals Don’t Consider State Insurance”
In Rajasthan, the government has claimed that Covid-19 and black fungus are treated for free as part of the Chiranjivi Yojana Even so, people are in debt because of the disease and the high treatment costs.
Hansraj Panchal from Lesarda in the Bund district tested positive and died of black fungus. After testing positive, Panchal was referred to a private hospital in Jaipur, where the bill had dropped to Rs 7 lakh.
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The family was already in debt and could not pay for the private hospital facilities. Panchal was then taken to a government hospital where he took his last breaths.
Panchal’s father told India Today, “He is survived by two children. We have to sell the house to repay the loan. “
“The government says Covid-19 and black fungus are treated if you have state health insurance, but nobody is considering it,” said Panchal’s brother.
Madhya Pradesh: Insurance company MIA, patient is still stuck paying premium
Rahul Sharma, a resident of Khandwa City, tested positive on April 25 and was in domestic isolation. But after his situation worsened, on April 30, his family took him to a private hospital that was also a Covid center in the city.
The hospital’s doctors performed an HRTC scan which showed his oxygen levels were decreasing and 28% lung infections.
He was hospitalized that same day. Rahul told India Today that he told his insurance company on the 1st of Rahul that invoices and documents were sent to the company through their app.
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The bill was worth Rs 80,000, including treatment, hospital room rent, multiple tests, and medication. But Rahul said that despite repeated attempts, the company neither responded to the medical claim nor paid the money. “This is not a small amount for me as I don’t do a job these days and have taken out a gold loan to pay the hospital bills,” Rahul said.
He also claimed that he is now paying monthly interest on his gold loan for the second month. Rahul is now considering going to a consumer court as he feels cheated and has no other choice.
Argument of the insurance agent
Amit Kumar Pandey, health insurance agent for Star Health and Allied Insurance Company in Varanasi, said that all of its clients have suffered the same fate. He told India Today that despite having a cashless facility, no hospital was willing to cashless treatment of Covid-19 patients during that time.
“So the insured were admitted to the hospitals paying cash and thinking about getting the money back from the insurance company.”
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Although experts have said that insurance companies cannot refuse the claims, people need to know the procedures and have proper documentation in place.
Ashish Jhamb, Director and COO of Infina Insurance Broking, told India Today, “There are well-defined guidelines so that an insurance company cannot say no to a Covid-19 claim. People have to be aware and have the right documents. “
“The problem is the hospitals that don’t properly inform and guide patients,” he added.
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