I do not want to remember that day, because even the faintest flicker of its memory brings a pain that is profound and hard to put into words. It was around 6 pm when I returned home from office. My husband was sitting at his work desk, quietly going through his medical reports. Two days earlier, he had been diagnosed with Hepatitis E. The doctor had advised rest, dietary control, and a few medicines. Some test reports were still pending, but we were not overly concerned. The main diagnosis had already been made, and we believed we were dealing with a manageable situation.While we were talking, my husband received a call from the laboratory. They informed him that his leptospirosis test had come back positive. I clearly remembered the doctor mentioning this test earlier, saying it was a fairly common infectious disease and that he was ordering it only to rule out all possibilities. At that point, we did not even know what leptospirosis was. What unsettled us far more than the unfamiliar name was the urgency in the lab technician’s voice. He insisted that we contact the doctor immediately. We called the doctor, and fortunately, he answered the phone. The moment he heard the name of the disease, his tone changed. He instructed my husband to immediately seek admission to the hospital.
I asked my part-time house help to stretch her hours and stay with my 11-year-old son until I returned, or at least make some temporary arrangements. I was unable to think clearly. I grabbed my wallet and rushed to Max Super Speciality Hospital, Patparganj—the nearest hospital to our home and the one where my husband had already been treated as an outpatient. The doctor had informed his team in advance. As soon as we arrived, they attended to him immediately and began a series of tests. Amid the chaos, my husband tried to reassure me. He handed over his insurance details and asked me not to worry. It was a policy worth ₹50 lakh, and at that moment, we assumed it would cover all the expenses.My husband had renewed the policy only a week earlier. We had thoroughly examined all the details and were quite satisfied, so there seemed little reason to worry. However, when I went to the billing counter, I was told that this hospital did not fall under the cashless panel of this insurance. This revelation came at a time when my mind was already struggling to function clearly. There was urgency to complete the billing so that my husband’s treatment could begin immediately.My husband had been diagnosed with leptospirosis. It is a rare bacterial infection caused by Leptospira. It is usually transmitted through water or soil contaminated with the urine of rats. What makes the disease dangerous is that it progresses very quickly. It needs quick treatment. Sometimes it may worsen within hours. It can lead to liver and kidney failure, internal bleeding, or lung complications. Early diagnosis and immediate medical treatment are critical, as timely antibiotics can significantly reduce the risk of serious outcomes.
But my life seemed to collapse at the billing counter. My salary account card had very little money in it. I called the insurance coordinator from my office. God bless him-he picked up the call immediately, reassured me, and asked for my office ID. I was so shaken that I could not even recall it. He assured me and did his checks. He asked me to submit the basic amount and said he would speak to the TPA team and manage the rest.At a time when I was literally trembling, unable to process facts and gripped by fear, this support felt like a relief beyond words. This is what insurance is meant for—not to force you to change hospitals at the last moment or leave you stranded in a crisis. Throughout my husband’s treatment, I received full support from my office insurance coordinator. He even helped ensure that we received the maximum possible amount from the insurance company during the final settlement.When my husband finally came home, I spoke to the insurance agent who had charged us a substantial amount for a policy that failed us at a time of utmost need. The response we received was casual and dismissive: “Yeh ho jaata hai kabhi kabhi.” We had so diligently checked everything in the policy before making the payment. The first thing we checked was whether our nearest Max hospital was included in the network panel. And what came as a painful blow was this last minute chance by the insurance company.Lessons and takeaways from my experienceYes, an insurance company can change its network hospital panel at any time, even after you have taken out a policy. Insurers regularly update their list of hospitals, which means a hospital that was in-network when you bought the policy could be removed later.Contracts between insurers and hospitals are frequently renegotiated. If both parties cannot agree on rates, the hospital may be dropped from the network, directly affecting access to cashless treatment.“Cashless Everywhere” initiativeAs of January 2024, the “Cashless Everywhere” initiative allows you to receive treatment at any hospital, even if it is not part of the insurer’s network. However, while many news pieces have claimed it, I could not find any official confirmation, and one publication even reported that it entirely depends upon the prerogative of the hospital. My question is, should we let the family of a patient do the guesswork or research at a time they are struggling with crisis?Conditions for non-network hospitalsWhile non-network hospitals are now included, you may need to inform the insurance company at least 48 hours in advance for planned procedures or within 48 hours in the case of emergencies. But do emergencies come with a 48-hour warning?Cashless vs reimbursementIf a hospital exits the network, treatment may shift from a cashless to a reimbursement model, meaning you may have to pay upfront and claim the amount later. Again, the patient here is at the receiving end, and the whole purpose of insurance is wasted.New health insurance rule changes—but please verify with your insurance provider to avoid a last-minute hit.1. Cashless treatment at any hospitalYou may now receive cashless treatment even at hospitals that are not part of your insurer’s network. Earlier, this benefit was limited to network hospitals. Disclaimer: Please verify as policies have fine prints that may rule otherwise.2. Faster claim clearance timelinesInsurers must approve cashless claims within one hour of admission and settle final claims within three hours of discharge. Delays may require insurers to bear additional hospital charges.3. Reduced waiting period for pre-existing conditionsThe waiting period for pre-existing diseases has been reduced from four years to three years. 4. Ayush treatments recognisedHealth insurance policies must now cover Ayush treatments-Ayurveda, Yoga & Naturopathy, Unani, Siddha, and Homeopathy-subject to policy conditions.5. Shorter moratorium periodThe moratorium period has been reduced from eight years to five years, after which claims cannot be denied due to non-disclosure except in cases of fraud. 6. Claims across multiple policiesIf you hold multiple health insurance policies, you can combine them to settle a single hospitalisation bill. For detailed guidelines read Master Circular on IRDAI (Insurance Products) Regulations 2024- Health Insurance dated: 29.05.2024
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