Trauma: No insurance cover

Hyderabad: Trauma and emergency care patients who are rushed to hospitals are not being treated under insurance cover. Hospitals are asking for payments and requesting them to take re-reimbursement later as there is no time to get insurance clearance.

The problem is that many of the 32 main insurance companies have sub-clauses requiring prior approval. It is not possible to quickly secure clearance in an emergency.

Insurance official Bharadwaj hospitals have been advised to seek payment even in trauma cases as the cost of essential medicines, bandages and cotton are not covered by insurance. Neurology costs too are not covered completely.

“The nature of the injury has to be very clear before insurance approval. Therefore we have asked hospitals to opt for this system,” he said.

In cases where hospitalisation is required, there is time to secure approval.

A senior official of a hospital administration department said, “We face these problems with patients who have recently taken insurance and their lock-in period is not complete. There are also patients whose family is covered by group insurance which has been used by some member earlier in the year. It is difficult to get clearance in such cases, and the hospital insists on payments at the time of discharge.”

While insurance is easily available for the young, those older than 45 years have to ensure that they read the documents closely as there are many clauses that exclude underlying illness or where coverage is close to nil.

Ms Rithika Johari, an insurance agent, said those who are diabetic have to disclose the condition before taking the policy. The reason for this is that diabetes complicates many other diseases.

“If the person is hospitalised and it is found he was hiding the disease it may lead to a dispute. Also, the premium increases with age as the risk factors are higher.”