Are you considering taking out health insurance? The devil is in the details – The New Indian Express

Express press service

Paying your hospital bills against your insurance claim can give you headaches for days. Most of the health insurance policy holders are not fully aware of the terms and conditions of the insurance companies and then feel cheated.

It is therefore essential to get a complete answer to your doubts before getting your hands on a particular font. In addition, according to experts, medical costs are increasing because of insurance.

“Hospitals tend to charge more when they learn that patients have medical insurance. So many entities like Ministry of Health, Insurance Regulator and Indian Medical Association (IMA) need to step in to streamline the whole insurance settlement process,” said one of the experts who did not want to not be quoted at TNIE.

During the Covid pandemic, even the prices of basic drugs were increased. Thus, fair practices are not followed by the healthcare industry and all the blame is put on the insurance industry, according to experts.

India’s Competition Commission (ICC) has ordered an investigation into allegations that some large hospital chains are abusing their dominant position and overcharging patients for rooms and medical equipment.

Limits of health insurance plans
Purchasing health insurance does not mean that all your health expenses would be covered. There are different limits and ceilings under a health policy, and people would do well to know about them in advance.

“In most cases, people don’t know the different components of medical expenses covered by their policy. They randomly choose a policy thinking that all their medical expenses will be taken care of,” said one of the experts.

“The lack of standardization, whether in treatment protocols or in the application of industry standard coding, results in an arbitrary line of treatment to maximize profits. Payers review these health claims to waste and other discrepancies, thereby denying or adjusting claims,” Vandana Bhardwaj, Principal and Senior Vice President, Medlnsight-Milliman said.

Also, people should be aware that just having a policy with a higher sum assured does not mean that their bills will be paid up to that limit. They should know the room rent ceiling which is one of the most important deciding factors in the final settlement of their hospital bills.

“Choosing health insurance plans that meet the specific needs of an individual/family is of paramount importance. There are various product offerings that a consumer can choose from based on parameters ranging from PED waiting period, specific benefits such as unlimited auto-recharge of sum assured, annual health checkups, air ambulance coverage, maternity coverage and OPD coverage, among many others. said Ajay Shah, Chief Retail Director, Care Health Insurance.

All this, in addition to benefiting from cashless treatment in the event of hospitalization and coverage of pre- and post-hospitalization expenses,” Shah added. An insurance expert says that people should opt for this policy which has no limit on the room rent.

“It is always better to pay a higher premium for a policy without such limits than to go for a cheaper policy with a sub-limit,” said one of the insurance experts.

Know your health expenses
Experts say consumers should question their health and their lives at stake. They have every right to know what their doctors recommend and why. High cost does not mean better treatment or better doctors, they argue.

“Doctors are recommending expensive stents, drugs, etc., because they are incentivized. Consumers should be aware of all riders and the fine print of their health policy if they are insured,” one expert said.

Experts give examples of the introduction of a few drugs – very large doses of antibiotics, etc. – for the treatment of diseases, which have not been proven on the basis of evidence to cure the disease more effectively than a lower dose of the same medicine. Industry insiders also cite examples of robotic surgeries costing three times as much as laparoscopic surgery without providing additional clinical benefit for the removal of cancerous fibroids from the uterus.

Unlike India, in countries like the UK, there are independent bodies that evaluate every new test, every new procedure, etc. from a health economics perspective. Here, no one knows if the new equipment is as good as the existing one.

Experts also point to a new practice of hospitals adding new line items in hospital bills.

“I have some bills from some hospitals where I observed that patients who had angioplasty for stent placement, those hospitals started charging a separate item called stent implantation fee. But the stent itself means putting the stent on the coronary artery, so why this extra burden”, asked one of the experts.

“Such innovative hospital practices lead to greater scrutiny of health insurance claims, which if not done would become a practice,” he said.

If you don’t want to have a shock when you are discharged from the hospital, it is very necessary that you understand both the limits of your health policy and the cost of health expenses.

Paying your hospital bills against your insurance claim can give you headaches for days. Most of the health insurance policy holders are not fully aware of the terms and conditions of the insurance companies and then feel cheated. It is therefore essential to get a complete answer to your doubts before getting your hands on a particular font. In addition, according to experts, medical costs are increasing because of insurance. “Hospitals tend to charge more when they learn that patients have medical insurance. So many entities like Ministry of Health, Insurance Regulator and Indian Medical Association (IMA) need to step in to streamline the whole insurance settlement process,” said one of the experts who did not want to not be quoted at TNIE. During the Covid pandemic, even the prices of basic drugs were increased. Thus, fair practices are not followed by the healthcare industry and all the blame is put on the insurance industry, according to experts. India’s Competition Commission (ICC) has ordered an investigation into allegations that some large hospital chains are abusing their dominant position and overcharging patients for rooms and medical equipment. Limitations of health insurance plans Joining a health insurance plan does not mean that all your health costs would be covered. There are different limits and ceilings under a health policy, and people would do well to know about them in advance. “In most cases, people don’t know the different components of medical expenses covered by their policy. They randomly choose a policy thinking that all their medical expenses will be taken care of,” said one of the experts. “The lack of standardization, whether in treatment protocols or in the application of industry standard coding, results in an arbitrary line of treatment to maximize profits. Payers review these health claims to waste and other discrepancies, thereby denying or adjusting claims,” Vandana Bhardwaj, Principal and Senior Vice President, Medlnsight-Milliman said. Also, people should be aware that just having a policy with a higher sum assured does not mean that their bills will be paid up to that limit. They should know the room rent ceiling which is one of the most important deciding factors in the final settlement of their hospital bills. “Choosing health insurance plans that meet the specific needs of an individual/family is of paramount importance. There are various product offerings that a consumer can choose from based on parameters ranging from PED waiting period, specific benefits such as unlimited auto-recharge of sum assured, annual health checkups, air ambulance coverage, maternity coverage and OPD coverage, among many others. said Ajay Shah, Chief Retail Director, Care Health Insurance. All this, in addition to benefiting from cashless treatment in the event of hospitalization and coverage of pre- and post-hospitalization expenses,” Shah added. An insurance expert says that people should opt for this policy which has no limit on the room rent. “It is always better to pay a higher premium for a policy without such limits than to go for a cheaper policy with a sub-limit,” said one of the insurance experts. Know your health spending Experts say consumers should question their health and their lives on the line. They have every right to know what their doctors recommend and why. High cost does not mean better treatment or better doctors, they argue. “Doctors are recommending expensive stents, drugs, etc., because they are incentivized. Consumers should be aware of all riders and the fine print of their health policy if they are insured,” one expert said. Experts give examples of the introduction of a few drugs – very large doses of antibiotics, etc. – for the treatment of diseases, which have not been proven on the basis of evidence to cure the disease more effectively than a lower dose of the same medicine. Industry insiders also cite examples of robotic surgeries costing three times as much as laparoscopic surgery without providing additional clinical benefit for the removal of cancerous fibroids from the uterus. Unlike India, in countries like the UK, there are independent bodies that evaluate every new test, every new procedure, etc. from a health economics perspective. Here, no one knows if the new equipment is as good as the existing one. Experts also point to a new practice of hospitals adding new line items in hospital bills. “I have some bills from some hospitals where I observed that patients who had angioplasty for stent placement, those hospitals started charging a separate item called stent implantation fee. But the stent itself means putting the stent on the coronary artery, so why this extra burden,” one of the experts questioned. “Such innovative hospital practices lead to greater scrutiny of health insurance claims, which, if not are not carried out, would become a practice,” he said. If you don’t want to have a shock when you leave the hospital, it is very necessary that you understand both the limits of your health and the cost of health expenditure.

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