Health insurance companies pursue customers till policies are sold. Then they disappear. The nature of business has already changed the treatment mechanism. A market awaits capture. Without stringent regulation, where is the industry headed? vibha varshney reports
Saif Siddiqui spent a little under Rs 14,000 on his appendicitis operation three years ago. The 35-year-old dentist from Bhubaneswar relied on an insurance cover for his family from Reliance General Insurance Company Ltd. He paid Rs 5,184 as premium for the policy.
The surgery happened two months after he got the policy and Siddiqui filed the claim a week after the operation. The insurance agent promised a cheque at the earliest. When it did not arrive for several months, Siddiqui started making calls. The reply was always the same his claim was being processed.
He visited the companys office. He was informed that his claim had been rejected because it was a case of a pre-existing disease. Arguments along the lines that appendicitis could not have pre-existed and that he was operated immediately after severe pain and fell on deaf ears.
The agents though persuaded him to go for a fresh policy since his earlier policy had lapsed.Siddiqui bought it with the hope that he might still be able to recover the money he spent on his operation. His clinic keeps him too busy to move the consumer court, or write persistently to the company.
The company told the Down To Earth correspondent that it would not be able to provide any information because the case was old.
Siddiqui does not want to renew or get into such a racket anymore. We get health insurance cover hoping it will be of help in difficult times. But such experiences shake ones faith in the system, he said, adding, he still gets calls from insurance agents at odd hours. More than 75 per cent of the insured get to hear about policies through insurance agents. According to the Insurance Regulatory and Development Authority, a Central autonomous body, insurance companies, public and private, reject 30 per cent of the health claims. Of this, 90 per cent are because of the pre-existing disease clause in policies, which agents do not reveal while marketing their policies.
Reality hits when a customer becomes a patient.