Of Healthcare, And Insurance

The last month has been somewhat of a challenge for our family. There were some medical emergencies that had to be tackled. It not only involved dealing with doctors, hospitals, but following that it meant dealing with the insurance agents, TPAs etc.

Here are some observations about the experience:
1. There is a general sense of arrogance that one can perceive in the medical community. Be it the person who does the admission in the hospital to the highest personnel. I somehow was reminded of 'MunnaBhai M.B.B.S' many times during these interactions.

2. Either the medical practitioners really do not have enough time to give to their patients, or they create this perception. You do not get enough time to talk satisfactorily with a doctor. They just come and swoop by as soon as they can. May be it is required to not disclose everything to the relatives of patients. But I am not sure at the point where the line has been drawn currently. And maybe, if we consider the number of patients (and their relatives) vying for their attention, it is probably not their fault.

3. It has become so difficult to diagnose diseases these days. I am certain that it is of primary importance. But though, the number of tests that get conducted before and after patients are treated, have increased substantially over recent times, diagnosis continues to remain a challenge.

4. Speaking with doctors / nurses is an art. One is dependent on them to take care of the patient, and so has to be very careful about how to deal with them

5. One word of caution while buying mediclaim / health insurance - Be proactive, and ask your agent details about the policy. Some of the things that are conveniently left to be fetched by the policy holder are:
- The agent should be strong enough to explain the policy intricacies, guide you through the entire claims process, and have a "will-do" attitude. He/She should ideally lead the claims process, for it is his/her duty - otherwise, what is their use as an agent. Else for what reason is this person earning from your premiums that get paid to the insurers
- It is extremely important to intimate the TPA or the insurance company of any medical emergency / hospitalization that will lead to a potential claim ASAP. That ways there is no chance for them to use that as an excuse to reject your claim
- When taking a policy, one needs to check what the cooling-off period is. Cooling-off period is the duration from the start of the policy, during which time, pre-existing diseases are not covered in the policy. Now, the definition of the pre-existing diseases is very wide. It is not limited to diseases that you have been diagnosed or treated for before taking the policy. It includes even those that you have but might not be aware of. The insurance companies and TPAs have a long list of such diseases. If you suffer from any of these, during the cooling-off period, there is no convincing that will work, to claim that this was not something that you already had while taking the policy
- Ensure that all originals (prescriptions, bills, test reports etc.) are with you. These will have to be submitted in original to the insurers.
- Ensure that everything in the medical process gets recorded. For e.g. due to emergency conditions, if you have to be shifted to a bigger hospital, ensure that proper reasons are written in the discharge card of the first hospital

The entire thing reminded me of Michael Moore's Sicko.