No insurance when one needs it most

India
April 21, 2013 8:26am CST
Insurance more particularly ‘health insurance’ is needed most after age of 50 when diseases start appearing; these may be hereditary, acquired from environment, food etc. [b]But most insurance deny to sell health insurance to senior citizens aged 60+; they don’t cover pre-existent diseases; if covered the premium are very high. Moreover you have to get treated in certain hospitals only.[/b] I had bought one such insurance through a government owned insurance company clearly stating the pre-existent diseases and got treated in the network hospital in the list. I was issued a ‘Cashless’ card was told just go get treated showing this card and leave after treatment; rest we take care of. But the hospital didn’t leave me, I had to pay the billed amount in full. [b]I am calling to the agent from whom I bought this on line and to the customer care of this company; no response only false promises. Now tell me what should do? Please respond comment and share your experience if any?[/b] Thanks in advance. Professor Dr. Bhuwan Saraf. PhD. April 21. 2013. Cheers have a lucky day ahead.
2 people like this
10 responses
@viju0410 (2286)
• India
22 Apr 13
Hi, Most of the 'cashless' claims has also become a 'reimbursement' claims. Now that you already paid under the cashless scheme, you can send all your original medical papers to the concerned agency (only after speaking to the concerned) and they will reimburse the expenses incurred. Also you have to inform the insurance company about being 'hospitalised under cashless' scheme within their stipulated time frame. Oflate, some of the private insurance companies are coming up claiming coverage of all generations.
1 person likes this
• India
22 Apr 13
Viju beti I had bought one such insurance through a government owned insurance company clearly stating the pre-existent diseases and got treated in the network hospital in the list. I was issued a ‘Cashless’ card was told just go get treated showing this card and leave after treatment; rest we take care of. But the hospital didn't leave me, I had to pay the billed amount in full. So i wanted reimbursement, send all papers, I am calling to the agent from whom I bought this on line and to the customer care of this company; no response only false promises. I will wait for 15 days next file case in consumer forum.
@marguicha (97240)
• Chile
22 Apr 13
I am sorry this happened to you, Bhuwan. In my country there is a government health insurance where you pay 7% of you salary whatever it is and they give you health care. Besides that, if you want better health care, there are health insurance companies that are quite expensive, but cover a quicker and better health care. And the government has made a list of some illness that have special help. For instance, I have paid a small percentage of what my cancer treatment has costes. But I have not gone for a couple of years to the dentist because that is not covered by any insurance and is very expensive. We also have a place where we can fileout complaints if we are scammed, but it doesn`t work perfectly well in every case. I don`t understand how a government owned insurance company can cheat you. I hope you solve well the problem.
• India
22 Apr 13
Sister Margarita Thanks for the details.While in job i had that kind of insurance they call-GROUP INSURACE; but after i retired in April 2006 it is gone, well i will wait for 15 days and if not solved file a case in the consumer court.
@artemeis (4053)
• China
22 Apr 13
It is true that different insurance companies have different ways on how they underwrite their policies but the conditions are all more or less the same as far as age or medical health is concern. While it is true that there are some companies that does cover some medical health conditions, these companies have additional requisites that need their insured be examined if their medical condition is cured and managed before the insurance company can insure the individuals but not without additional on their payable insurance premiums. In your case, the agent of the insurance company in this case has clearly mishandled your application to cause this inconvenience of non payment for you. I doubt if you can get this solved all on your own. You need to get a lawyer for your case to demand some compensation which could be a partial claim or full refund of your premium paid for this particular insurance policy. Whatever the case, I hope that you will be able to resolve with your insurance company here.
• India
22 Apr 13
Thanks for response, artemeis, yes they did medical examination through their sister hospital here,they are playing foul now, so i will wait for 15 days and if not solved file a case in the consumer court.
@dagami (1162)
• Rome, Italy
21 Apr 13
do not bother the agent anymore. they have already encashed their commissions and they won't help you now. i suggest that you go to the office of this insurance company and file for a refund of your expenses at the hospital. if they make it hard for you, ask a lawyer to do the job. it is a government owned insurance company and it will not go bankrupt.
1 person likes this
• India
22 Apr 13
Thanks for response,dagami, yes the agent has left job, the office does not reply to emails so i will wait for 15 days and if not solved file a case in the consumer court.
• India
21 Apr 13
Sir,i understand your situation.Now there are two things to it.Before you purchased that insurance you should have taken review from people who bought it,both online and offline.This would help us in getting some picture about them although it may or may not be precise.Coming to the problem,although you have called them,it has not helped.I would suggest you to email them on the things and ask them for things.It would also serve as a proof for your communications because telephone records are easy to tamper with unlike email communications.If that also do not show any response, then you need to approach consumer court or other higher authorities for justice.There are many cases like this,which are addressed in this fashion by consumer courts.Health insurance is definitely costly.The earlier you take it, its better instead of waiting for long.Or you need to get those corporate health insurances.And on another note, i would suggest you to check for other insurance companies for your future health needs.It does not make any sense in continuing with them if they are not co-operative or not helping you when you need it most.Do keep us updated on the progress and hopefully things will work out fine and better for you.Thanks!
1 person likes this
• India
22 Apr 13
Thanks for response and welcome to mylot and my discussions Asok, well i have tried emails, talk over phone, i have all proof and some voice recordings too so i will wait for 15 days and if not solved file a case in the consumer court.
@cotruelove (1038)
• Denver, Colorado
21 Apr 13
Thanks for the discussion. As you know I am a senior citizen also. Fortunately, because I live in the USA we do have Medicare and Medicaid to help with medical expenses. I am on Medicare because of my age and am allowed several choices in the way of types of coverage. There is a base plan that the government provides which everyone my age and older is required to pay and is administered by the government through an insurance company. But there are several other types of coverage which a person can enroll in and receive additional benefits beyond the base plan which usually covers 80% of the cost of treatment for health issues. Since ours is administrated by the government, I can call their phone number and resolve most of the assistance with any problem in regards to coverage or payment of bills. However in my state, there is also an insurance commission who regulates the way the insurance companies operate. Although Medicare is required by the Federal government, there is an insurance company who does the actual type of coverage and they are the ones who may require additional money beyond the base demanded by Medicare. I was paying for a very expensive plan last year, but this year changed to one that the cost is only the base Medicare cost. The one I had last year, paid for everything but only a portion of the cost of medications. The one I have this year, I have a co-payment for services. It is all a bit confusing but in the long run, the plan I have this year has cost me less than what I was paying last year just in insurance premium payments. The benefit of having an insurance commission and the Federal government involved, is it does keep fraudulent claims in regards to benefits by an insurance company from happening. I am not familiar with how insurance works in India. Nor what regulatory agency controls the government may have in place to keep you from being scammed by either an agent, an insurance company, a hospital or a physician. Here you can also hire an attorney to deal with fraud and sue those who misrepresent themselves as something they are not. I pray you were not a victim of fraud by an agent who has misrepresented the insurance coverage. Good luck and I hope you get some resolution to the problem.
• India
22 Apr 13
Thanks for the details sister Marydon Here private companies are better than government ones, soon i will buy. Hope you and your hubby are fine My blessings and hugs to both of you.
@maximax8 (28490)
• United Kingdom
21 Apr 13
Hello Professor 2010. It is essential in a country with a paying health service to have high coverage of health insurance. I live in England and we have free medical care on the National Health Scheme. Care from a National Health Scheme can be awful. It is pricey to see a private dentist but is essential for a complicated procedure. You told them the pre-existent diseases and you had a cash less card of insurance. It was awful you had to pay for treatment. I hope that you get on well calling the agent.
1 person likes this
• India
22 Apr 13
Hi dear max What i learnt is that agent has left job, so i will file a case in consumer court only.
@nicanorr (1789)
• Philippines
21 Apr 13
Try to communicate with the agent from whom you bought the card, explaining the kind of treatment you had at the hospital where you were treated. If not, try to write or see personally your government insurance commissioner of your country. It takes charge of establishing harmonious relationships between insurance companies and clients as well as assistance in ironing out issues. We've such agency in our country. I do hope this helps.
• India
22 Apr 13
Thanks for response, well i am calling the agent every now and than but no one lifted, last evening some one answered, whe asked are you mr.xxx; he said, no i am yyy; xxx has left job. so i will wait for 15 days and if not solved file a case in the consumer court.
@Dominique25 (9476)
• United States
21 Apr 13
Yes it is really awful how health insurance works. It is so sad that so many people have health issues and aren't able to get the care they need. I think it would be a good idea for you to keep trying to contact the company and any other government programs that could help take care of that bill for you. I hope you are able to find a solution to this problem quickly.
1 person likes this
• India
22 Apr 13
Thanks for response, i will wait for 15 days and if not solved file a case in the consumer court.
@KrauseHome (35293)
• United States
22 Apr 13
Sorry to hear about this my friend, and hope you can get some of this straightened out soon. Anytime you have issues with medical you need to do some research before getting help from a company without knowing someone personally responsibility to clear up this situation. ; often think many times it should be something there is more help from instead of thinking you are covered and then finding out you were not or only partially covered. I think overall it would be better if it was a case by case thing for them to decide instead of being so general with everything.