Under the Knife and the Insurance Fraud

On April 1, 2010 I underwent surgery for my haemorrhoids, a long standing problem which now required radical treatment. In the past I used all pathies but things did not work out so excision was the only option. The uncomfortable part, apart from the post-op pains encountered in the loo, was that I was forced to resort to private care because the public health facilities in Mumbai are in real bad shape. When government employess and politicians dont have faith in them it was difficult for me to  take the risk. So I went to Jaslok Hopsital where a surgeon friend was attached and since I had insurance cover from my employment I thought the cashless policy would make life simple. But let me tell you the experience with both the hospital and the insurance company and their TPA is a nightmare. The cashless policy is certainly not cashless. The hospital does not trust the insurance company and they insist on a security deposit. So I had to pay a deposit of Rs. 10000 upfront on admission.

The surgery went off fine but the nursing care at Jaslok hospital was atrocious. The nurses are ill trained. They may be nice persons but their nursing skills are very poor. The first day after surgery I was on a drip and each time a new drip was attached, I would notice bubbles and had to stop  the drip myself until the nurse came back after I paged her. This was repeated and thus shows sheer callousness, besides risking the life of the patient. We cant blame the nurses fully because hospitals pay them miserably and hence the good nurses fly off at the first opportunity. On the flip side the food was good! Not much else to say about the quality and efficiency of the hospital. Even things like lifts take ages to come and patients have to wait endlessly and often in pain. Even though Jaslok is a Trust hospital its charges are phenomenal. And without informing you they even change charges. Completely non-transparent. My surgery cost me Rs. 60000, that is a whopping unit cost of Rs. 20000 for each haemorrhoid excised!! And this was supposed to be a minor surgery.

The insurance business let me tell you is a complete fraud. They say cashless but you end up paying a substantial amount because they dont sanction the full amount and dont assign any reason. And then you have to struggle with them to get them to pay as much of the bill as possible. In my case they made a final sanction of only half the amount and hence on discharge I had to pay half the bill, apart from the security deposit which I will be refunded when the insurance company pays the hospital the promised amount. And I was told this could take upto 2 months. Now that I have started a process of questioning the TPA and the insurance company this could even get prolonged.

Over two decades I have paid health insurance premiums totaling Rs. 3 lakhs. If I had put the premiums I was paying annually in a recurring deposit account the value today would have been over Rs. 10 lakhs. The capital would have been mine and this I could use when  needed for any such healthcare. No wonder the Singapore government does not trust insurance and instead opted for precisely this concept which they called medical savings accounts. So like PF you save a proportion of your income with a similar contribution from the employer and draw on that when you need it. I think thats a better option if healthcare has to remain an individual responsibility. Ofcourse the ideal would be to have a universal access healthcare system like Canada or UK or something similar to what Thailand has achieved recently.

So my suggestion is please dump health insurance as it is not worth it. In the absence of universal access it is wiser to save money which we would pay as premium in a separate account so we have control over the capital. To cover larger risks, life insurance with a critical care rider is a better option because the capital we invest remains in our name and a small mortality charge covers us for risk of the big diseases like cancers, dialysis, cardiac surgeries etc..