Dengue patients struggle to get approval for insurance claim, whom to blame?

The rise of Dengue cases in India has caused much distress to patients who are not able to get their insurance claims approved. While hospitals have been accused of using this unfortunate situation to make money, they blame insurance companies for pulling back from their responsibility.

Data suggests, every year approximately 33 million dengue cases occur in India, accounting for one-third of the worldwide dengue burden. September end to October is the peak of dengue season, wherein both cases and deaths are the highest each year, causing a lot of panic and anxiety amongst Indians. During this period of havoc, dengue patients fall prey to exploitation, bearing huge medical expenses without getting their claims approved by medical insurance agencies. The hospital administrations blame the insurance agencies for not approving the claims, while the insurance agents point their fingers at the hospitals for unnecessary admissions and medical expenses. The blame game never ends, and ultimately, huge medical bills are born by the already distressed patients who can do nothing and find themselves helpless and cheated.

The distress of the patients: Pranav Bagai of New Delhi was admitted to Holy Family hospital in emergency post-midnight on 27th September after he tested positive for Dengue alongside typhoid. His platelet count was constantly monitored and reported to be 1,60,000. After spending five days under medical care, he was discharged on 2nd October after much hassle as the TPA did not approve his case and asked the hospital to justify the admission against an OPD treatment based on the platelet count. As the hospital did not "justify the case," the parents of the patients had to bear all the medical expenses even after having an insurance policy.

Akhlesh Jat reported a similar case from Ahmedabad, wherein he was admitted for Dengue, having a 103-degree fever, but was denied an insurance claim by Star Health and Allied Insurance Co. Ltd for a platelet count above 1,00,000. He posted his grievance on LinkedIn, opinionizing that the doctor reserves the right to decide if the admission was necessary, not the insurance company.