Partial View – The Hindu BusinessLine

A long time ago, the CEO of a health insurance company told me, ‘Every Indian needs health insurance.’ I add, ‘and cataract surgery’.

This is usually part of any hospitalization insurance in India, so let’s take a look at some dark points I came across when a family member was having cataract surgery.

It was his insurer’s network hospital, so he presented his insurance card and the hospital received a pre-authorization for ₹25,000. In fact the insurer told the hospital this is our guy and we will pay for this operation.

Almost all hospital policies have lower limits for cataract surgery, but this policy was silent on that. So, ‘will the insurer pay the whole bill?’ was the next question.

Deposit for the operation

This hospital did not require a deposit prior to surgery, although I hear from others that they do.

But at the time of dismissal they were asking for a deposit of £68,000, the full cost of the operation. Don’t bother with the pre-approval they said once the insurance company pays us we will refund you.

“So cashless is pointless?” the patient asked me, irritated. I called the insurer with the same question and asked what the minimum cataract surgery limit is under this policy (coverage of ₹10 lakh).

The company representative said that sub-limits are negotiated individually with each network hospital and are NOT shared with the insured!

(My own health insurance policy from another company has a flat limit of ₹50,000 regardless of the sum insured. I can increase it for a small premium and intend to do so. I appreciated the transparency even if the coverage was less).

Cashless treatment?

Back to the current case. “What about cashless?” I insisted. He dodged the question, reassuringly saying that once the hospital submitted the application, approval would be granted within an hour.

The hospital said they would send the application that same afternoon, and the doctor, when asked, kindly agreed not to insist on payment until the check-up scheduled for the next day.

I say “friendly” because the hospital could end up caught between two strangers and, after providing its services, chasing down bills.

The insured was appalled that he, too, might have pursued the hospital for a refund. He also had options for more sophisticated lenses, but the opacity of his directive limited his vision. Similar to cataract!

(The author is a business journalist specializing in insurance and corporate history.)