No one’s happy with mediclaim, neither customer nor the insurer. The morass that is Indian healthcare.

by Arti Sharma, Dola Mitra, Lola Nayar. Outlook Magazine.

Two years ago, 67-year-old Rakesh Mathur, a pensioner in Mumbai, had what is euphemistically dubbed as a cardiac “episode”. Under the doctor’s advice, he opted for a bypass to sort out the three blockages in his heart. Mathur was least worried about meeting the cost of the surgery—he had been buying health insurance from a public sector company (one that he is chary of naming) for 12 years. But post-surgery, when he filed his claim, Mathur got another shock to the system. The insurance company refused to pay the entire amount of the Rs 3 lakh he had incurred on the surgery, saying the bill was inflated. After much discussion and threats to take the matter to the consumer court, the insurer finally caved in and paid the full amount.

More recently, Delhi-based professional Madhu S. had a similar run-in with a leading private insurer. He had to suddenly shift hospitals after doctors had difficulties diagnosing what was behind a strong allergic reaction. But Madhu was reluctant to approach the insurer at the second hospital. “There was so much aggression from the company. I started getting palpitations just thinking of dealing with them again,” he says. So his second insurance policy was put into work. Here too he had a similar experience.  READ MORE..