a group of people in a room: COVID-19 treatment: Dealing with denial of cashless settlement and huge deductions in health insurance claims


© Venkatasubramanian K
COVID-19 treatment: Dealing with denial of cashless settlement and huge deductions in health insurance claims

In the past few months, we’ve heard several stories of people with health insurance policies facing claim rejections, not getting cashless treatments, or having to pay hospital bills out of pocket for COVID-19 hospitalizations. There could be many reasons that insurers give for rejecting claims. Some situations are avoidable. You must ensure that a COVID diagnosis or treatment does not burn a hole into your hard-earned savings.

This article discusses some such key issues, along with actions you could take to avoid or reduce the financial burden of an already taxing health situation.

Claims declined for mild symptom cases: Health Insurance policies cover hospitalization treatments that are considered ‘necessary’ – where there is active treatment carried out in a hospital, under any local or international medical protocol. The claim could be declined if the hospitalization is only for monitoring or investigations, without active treatment.  In the current pandemic, isolation of a patient who is asymptomatic/ has only mild symptoms, where treatment could be managed at home is considered hospitalization without any active line of treatment and hence claims are declined.

What you should do: If you are diagnosed as asymptomatic or have mild symptoms, based on your treating doctor’s advice, you must explore home isolation as an option. If your current residence cannot accommodate isolation, you should prepare yourself for bearing the cost of isolation at a quarantine centre from your own pocket, since this expense is out of the scope of any health insurance policy.

Cashless facility declined, deposit is required: It is being reported that hospitals, part of the empanelled cashless network of insurance companies, are often not honouring cashless facilities. These hospitals are demanding huge deposits before admitting the