Health Treachery

Half of all health insurance claims in India face serious processing and payment disputes. The biggest diddle is the complex, legalese jargon used in the contract

- 

It is a deception that does not reveal itself when you are opening your cheque book and letting your puny signature validate a hefty payment.

That languid moment of signing up is filled with brochures, smooth sales pitches, limited-period discounts and the comforting assurance that you are 'covered.' The reckoning arrives later; in hospital corridors, billing counters and intensive care units. That's when you find out that the policy you faithfully paid for is only a contractual mirage. For it is in that moment of medical vulnerability that India's health insurance industry sheds its glossy marketing skin and reveals its true character ~ adversarial, evasive and shamelessly profit-driven. All but ready to bite.

Somehow, over the years, what was sold as protection has increasingly turned into obstruction. Claims are not facilitated but scrutinised for rejection. Compassion is replaced by clauses. And the system, instead of standing by customers in their most fragile moments, appears designed to wear them down until they either give up or settle for less than they are entitled to. Such a scenario is bad anywhere in the world, but in a country with limited public healthcare capacity and high out-of-pocket medical expenditure, it is not merely service failure. It is betrayal.

Denial by Design

India's health insurance market has expanded exponentially over the past decade, driven by runaway medical costs, tax incentives and aggressive private-sector penetration. Yet this expansion hasn't been accompanied by a corresponding improvement in trust or outcomes. Data released by the insurance regulator (IRDAI) shows that thousands of crores worth of health claims are repudiated or partially paid each year. Behind these numbers lies a disturbing pattern: denial has become a business strategy.