INDIA'S HEALTH INSURANCE RICOCHET

Half of all health insurance claims in India face serious processing and payment disputes. Rejections and part-payments are commonplace, with 'pre-existing diseases' and 'lack of disclosure' used to deny claims. The biggest rip-off is the complex and nearly-indecipherable legalese and language used in the contract

- RAJEEV NARAYAN

It is a fishing contest like no other, with you (the customer) being the intended catch. To reel you in, the fisherman offers carrots, promises and special bargains, all dipped in sugar and honey to make for a very sweet lure. When the time comes to give you the promised succour, the fisherman's tone and countenance back-track. His story turns into a devious red herring, a smoke-screen that Greek fable-spinner Aesop would have been proud of.

Let's cut short the parallels and get to the point, one where we speak of pain, heartache and financial misery. Let's talk of Indian healthcare and insurance. The numbers below prove that most promises made by this industry space are only in the headline, with the real story saying something different. It is akin to the words of a marketing superpower, which lacks in true delivery at a crucial time. Health insurers promise, advertise and shout from the rooftops – mostly with a forked tongue. When claims are filed by policy-holders, these same insurers shamelessly wash their hands off the entire matter.

A 2024 survey conducted by Marsh McLennan India and Mpower underlines this startling state of affairs. Surveying 100,000 respondents across 327 districts, the survey paints a bleak picture – 43 per cent of all health insurance claims face disputes, either through outright rejection or complicated part-payment schemes. The reasons offered by insurers are craftily worded to sound legal and valid – they range from 'non-disclosure' to 'pre-existing illnesses and conditions' and on to 'policy lapse. The outcome is universal – as often as not, the claim is denied, leaving in its wake a disillusioned consumer whose personal or family illness plays havoc with finances as healthcare costs hit the stratosphere.

A Very Murky Reality