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Is your health covered? Think again…

The last week has been quite a ride. What with Che getting admitted to be operated for stones, Cuckoo needing to fed 4 times a day and work, I didn’t have time for even a breath. But this post isn’t about my sleepless nights; it’s about making sure you’re covered with company health insurance and trusting the company you work for. This is our story…

We rushed Che after 4 hours of excruciating pain to Apollo ER. A few rounds of painkillers later he was sober enough to discuss further action with his doctor. The doctor recommended surgery; they’d use laser to powder the stones and try to remove whole if possible for analysis. Che was asked to get admitted immediately and they planned to schedule surgery the next day. As the paperwork started we called his company to check on his insurance details. (I am not naming the company or insurance in this post, just in case they think up something to sue me but if you want to know please ask.)

We were given the policy number and told total cover was for 4 lakh. Just before the HR guy hung up he mentioned a limit of Rs.20,000/- for kidney stones. We went ahead and gave this info to the hospital who said it was fine as most insurance companies have small pre-approval limits. As the paperwork was getting sorted we got to know that the OT was not available the next day so they would operate on that day itself. This sounded great as it meant less stay at the hospital so we closed on the paperwork and prepared for surgery. (I shuttled between home to feed and walk Cuckoo and the hospital).

Che was taken into the OT at 6pm and the operation went way beyond the expected 1 ½ hour until almost 9pm. That had me worried for a while until I was told that they had started 45min late. The operation went well and 2 stones were removed, 2 powdered and 2 left to come out on their own. (He had 6 – 2 in each kidney and 2 in the urethra – largest being 6mm and smallest 2mm) He was moved to his room by 12 and I got back home at 1am. (We didn’t stay over as he was in the general ward thanks to hospital running packed).

The next day the doctor came by at about 10:30am and we started discharge procedure. The paperwork was faxed over at 12 noon and the chase started. We started calling the insurance company and checking on progress every 1 hour. At about 3:30pm we called his company to ask them to put some pressure. To our surprise we were told we would be paid only Rs.18,000/- (insurance pays only 80%). When asked they said it’s a capping or limit set. We asked how they thought it possible that an operation, any operation can be done in 20,000. To this we were told that we should have found a hospital that would have done in it in that much. (That means we only could have gone to a Govt. hospital).

So now the company helping us was out; friends said not to worry as it’s the insurance companies call at the end; but then the insurance company declined it 4:30pm. We then approached the hospital to see if they could speak to the insurance company and help us out. The hospital guys checked and came back with an explanation. The insurance company would not pay and nothing could be done. It wasn’t their fault. The company Che worked for had wanted to cut down on premiums hence they had struck a deal with the insurance company and capped or limited payouts for almost everything. This meant low premium. So on paper when joining Che was told he had a 4 lakh cover but in small print is insurance was worth small change. His company had short-changed him; something supremely unethical I think especially since it concerns life.

Anyway the bill exceeded a lakh and Apollo hospital gave us a discount. The insurance company paid 18K and we paid the rest. A big lesson learnt.

This is our story and the reason we wanted to share it is to tell you to please check on your company provided insurance policies. Check the fine print and question it well before you ever need to use it. Don’t assume that you are fully covered and for safety get a personal health insurance too. If you belong to an Indian company double check for tricks. In recession MNC are less likely to cheat employees but then again don’t take my word for it. Check!

Photo Credit: Cartoon Stock

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