Why Health Insurers Are Sending Private Detectives To Your Door

How far is too far in preventing fraudulent claims? Policyholders question intrusive health insurance checks

- Shipra Singh

Medical insurance is what allows people to be ill at ease," goes the popular quote by Alfred E. Neuman, the fictional mascot of MAD magazine. But, this proved untrue for Rishabh Kumawtt. For him, using medical insurance for his mother's treatment led to private investigators showing up at his door.

In March, Kumawtt's mother underwent Ayurvedic treatment at a hospital in Bengaluru. It wasn't her first time at this hospital, nor her first claim—two years earlier, her insurer had settled a similar cashless claim. This time, however, after Kumawtt filed for reimbursement and received a call from an investigative agency requesting to verify the claim by visiting his mother's house. What followed left him flustered. "Two third-party detectives, not from the insurance company came to our house and asked us to fill out a form. The questions were strange, such as why was this treatment necessary and couldn't be done at OPD? Why did we choose this hospital and not go to one within 5km of our house? It felt like we had to justify every single decision we took during the treatment," he said.

After the two were done questioning, they dialled up someone and made Kumawtt's mother speak to them. "That person asked the same set of questions again," he said. That wasn't it. The two investigators asked Kumawtt to write everything again in first person on a blank piece of paper and sign it. "This was the most embarrassing part," he said. "At the time of signing the form, this agent clicked a picture of my mother signing it. But I didn't object. Next, he turned around and clicked a picture of the house. It was the last straw."