A routine visit to the ENT physician resulted in an immediate admission to the hospital for “acute follicular tonsilitis with quinsy.” Now we move to the main story which is less about health and more about health insurance.

The estimate for claim clearly mentioned the admission was for medical management with surgery as an SOS option, if required.

REJECTED: We don’t cover ENT surgeries for the first two years.

The main treating physician takes the time to write a note explaining that the admission is for medical management and no surgery is scheduled.

REJECTED: For the same reason by one person associated with the insurance company.

REJECTED: For the same reason by another insurance company person, who was considerate enough to reduce the waiting time to 12 months. (In other words, if you are alive to seek treatment after 12 months, you might raise a claim again.)

As the doctor expected, the patient recovers fast just with the medicines and is discharged on the third day. The patient pays and goes home. He has to work to pay the bills (including the health insurance premium).

Believing that the amount would be reimbursed now (as it was only medical management), the claim is re-presented.

REJECTED: “Patient paid and discharge.”

Applause!

According to your website, Care Insurance “is one of India's leading Health Insurance providers, with a claim settlement ratio of 95.2%.” Going by this experience, the numbers that constitute the 4.8% unsettled patients must be huge.

Your marketing department is doing a wonderful job.

But that is nothing compared to the astounding work of your Chief Excuse Officer. Refuse to settle for this reason and that until the patient pays and goes home. Then throw the masterpiece (don’t get distracted by the English): “Patient paid and discharge.”
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Bravo!