The young advertising executive had sharp abdominal pain as he left the office and headed home. The following morning, he had to be admitted to the hospital because the pain did not go away. The hospital informed him that he would require a “cholecystectomy,” a standard procedure that involves removing the gall bladder following some routine medical tests.
The anonymous executive with a Rs. 5 lakh health insurance scheme didn’t anticipate the total costs. When he was admitted to a non-network hospital, he had to pay the admission fee upfront as it was ineligible for cashless admission. The insurer told him that he would be reimbursed after his hospital discharge.
His brother used a credit card to cover the admission fee. After the procedure, the executive was informed that he would be required to pay INR 33,350 when he was released from the hospital. He had already paid INR 50,000 of his INR 83,350-rupees total bill at the time of his admission. The executive had to use his credit card again because he had no savings for such emergencies. The company’s third-party administrator, or TPA, informed him that he was only qualified for reimbursement of INR 42,330 when he contacted the insurer. He was told that the insurer would pay the sum within 30 days of receiving the claim, all bills, and the hospital discharge certificate. Consequently, the executive was required to pay about INR 41,000 from his pocket.
This executive’s experience is typical and illustrates why most insured individuals face out-of-pocket expenses (OoPE) during hospitalisations. Many insurance companies do not cover consumables, like disposable medical devices used in surgeries. High OoPE is a significant issue in the Indian healthcare system, particularly for lower-income families, as it creates a substantial financial burden, making quality healthcare inaccessible to many.
OoPE in India is estimated to account for 62% of all healthcare spending. Healthcare costs accounted for an average of 7.9% of annual household consumption expenditures (monthly home operating costs) for Indian families.
Here Are Some Suggestions For Reducing OoPE:
- Health Insurance: It is one of the ideal methods for reducing OoPE. Purchase as much insurance coverage as you can. *
- Healthcare credit line: Access a no-cost healthcare credit line for quick and easy access to funds you can borrow and repay for any medical expenses not covered by your health insurance.
- Preventive Care: Routine checkups, immunisations, and screening exams can assist you in identifying health issues before they worsen and become more expensive to treat.
- Negotiation: Try to work out a better deal with the healthcare provider to get maximum coverage at the most reasonable health insurance cost. If you pay in advance, many health insurance providers may give you a concession.
- Government Healthcare Facilities: These provide medical care at reduced costs or without charge. These facilities can be affordable, especially for routine checkups and minor illnesses, even though the quality of care may vary.
* Standard T&C Apply
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