Health Insurance - Inputs on Solutions

Below are the key issues and root causes related to health insurance. Kindly review them and help identify solutions to make Health Insurance more effective and transparent.

Health Insurance – Root Causes

1. Insurance agents just want to sell the policies by hook or by crook
2. Customers are not aware enough about needs from an insurance policy
3. Hospitals have a corrupt nexus with the insurance officials
4. Hospitals inflate the bills and do unnecessary tests as they know that the insurance company would bear the cost on behalf of the patient
5. The eligibility of room rents is based on the type of insurance cover
6. There is a lot of paperwork involved in case of a non-cashless insurance
7. Patients with health insurance are taken for granted
8. Many people are unaware about the usefulness of insurance policies
9. People think that they can go to a Government hospital if they fall ill and hence do not need a health insurance
10. Insurance companies have clauses which prevent genuine patients from taking the benefit
11. People ignore the exclusion clause while purchasing health insurance
12. People hide pre-existing diseases while buying health insurance
13. IRDA guidelines have many loopholes

Health Insurance - Key Issues

1. Health insurance policies have hidden terms
2. Wrong interpretations of policy conditions by insurance officials while selling
3. Advisors do not explain the negative parts to customer
4. Customer is confused while buying a health insurance as he does not know which is the right one for him
5. Hospitals inflate bills when the patients use insurance
6. Very high room rents leading to deductions in the claims
7. Reimbursements in case of non-cashless insurance are tough to get
8. Patients with health insurance are not given priority at hospitals
9. In Delhi hospitals, even with cashless insurance the patient is made to wait to get the paperwork done by the insurance desk more  

View all 17 comments Below 17 comments
I wish to point out that when any Indian is going out of India to another country, we are required to take an Insurance policy to cover our Medical needs if they so arise.
No Insurance Policy of India covers Diabetics, yet we have to take a policy cover for travel. Hence, if the eventuality of hospitalization does occur at the Foreign country for a Diabetic, the Insurance Company can simply not agree to reimburse/ cover the expenses on grounds of the traveler being a Diabetic. This is very unfair for Diabetics.
Who can resolve this issue? Can the Govt. look into this and bring out a Policy for Diabetics travelling Abroad.
I don't know if I'm addressing the correct circle for comments.

Rajeev Chandra
+91 9555224455 more  
I was not defending DOH but maybe I was being polite and hoping for additional support for our issues. You have written valid points - agree. I was not aware of other avatars in the past. more  
Dear Rajeev, you are being unnecessarily charitable, DoH doesn't deserve your defence. For one if they really were serious they would be submitting concrete & expert views to IRDA rather than seek views from the man on the street and come up with such a platitudinous compilation. Tell me does even a single point in their list throw any light or come up with any path breaking ideas? Second & more importantly, why do they close a discussion and keep coming up with same in a new avatar every now & then. DoH runs on our taxes and therefore better deliver rather than waste tax payers' money like this. more  
You are correct in pointing out that IRDA (Insurance Regulatory and Development Authority) is empowered to bring about any changes in the insurance space. However, any help from DOH to pursue these issues with IRDA is welcome. more  
Dear Friends, you are being misled. DoH has no jurisdiction in health insurance matters. That power lies with IRDA. DoH has raised this issue for the 3rd time in the last couple of months and every time I pull them up for misleading the public into giving their valuable time & inputs, DoH stop that discussion and float afresh as a new discussion after some time. Please beware & don't waste your time. If you are concerned about this problem, you will better utilize your time by pursuing IRDA instead. more  
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