Integrity Score 130
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Insurance Companies' argument: In an attempt to justify the insurance companies' stance to withhold the claims in both the above cases, LIC Agent Sanjay Singh compares hospitals to a shop and says, "Their focus is on selling as much of their services as possible, not ensuring the well-being of their patients. They will make unnecessary admissions, advise plasma therapies, ICU treatments, etc., whatever makes them more money as a business."
Bharat Lohia, Investment Planning Advisor from Meerut, also sided with the insurance agencies saying that they are always willing to assist their customers and only cases that are not genuine face claim issues. He mentioned that hospitals indulging in such activities get blacklisted by insurance companies, which affects the policyholders more. He suggested that IRDAI should impose penalties on hospitals as a more effective measure to curb the financial exploitation of patients over unjustified admissions.
Medical Perspective: Dr. Tannishtha Arora from Subharti Hospital brings the medical perspective to the table by stressing the severity of Dengue. Apart from high-grade fever, Dengue poses a risk of blood loss from urine, nosebleed or vomit if not managed properly or early. Dengue requires fluid replacement and constant platelet monitoring, for which the patient needs to be admitted. Dengue is deadly, and a patient's life cannot be put at risk by neglecting symptoms and not having them admitted.
Dr. Manas Mitra of Max hospital (Vaishali) adds to this argument by mentioning that the health condition of dengue patients is very unpredictable. Dengue patients are at a high risk of sudden collapse, and in some cases, the platelet count drops to critical within hours. Moreover, due to weakness, there is no scope for oral medication.
Conclusion: The hospital and Insurance companies should work in symbiosis to reduce the misery of Dengue patients instead of playing the blame game.