Volume 2 Issue 5 May, 2012
Patient, Doctor & Health Insurance!
Over the past decade there has been flood of health insurance schemes by numerous companies in India. Insurance companies have made profit of millions from premium and have spent a minuscule on payment for utilization by policy holders. People have realized that health care being a costly affair is more like a necessary investment than an option. Most people choose particular health insurance based on casual recommendation by someone or a scheme with least possible premium amount. Corporate sector picks up particular insurance and even changes it every year based on lowest bid it receives for its employees and hence individuals do not have a choice.
The most important aspect of all insurance schemes is that each of them has numerous exemptions! That may be related to time period since the first policy or particular illness or kind of clinical settings or type of intervention or maximum reimbursement for that category of Hospital etc. Paradoxically none of these can be understood well without input from doctors. Although most of inconvenience can be avoided in preplanned hospitalization but for many, emergency hospitalization can become a nightmare for lifetime. Sadly, most people get insured primarily for unexpected crisis. Majority of hospitals simply deny any facility even in emergency unless patient coughs up required advance amount until so called cashless insurance people approve the case! This may take couple of hours during working period of that company or whole day if admission was beyond working hours. Most important role of doctors in all insurance related issues about their patients is to have clear & open discussion with patients or relative, and also to be aware of limitations especially if the process involves planned hospitalization and in case of emergency, to do only necessary intervention until the insurance agency approves the cost. They need to be careful while filling the reimbursement form. Doctors neither can ethically neglect being aware of these neither issues nor be ignorant at the end, more so when a patient approaches doctor in complete faith.
