Tamil Nadu's Chief Electoral Officer Praveen Kumar made news recently when he chose to bring his father from North India and get him admitted in a government hospital in Chennai for treatment. That may well be seen as a refreshing departure from those in the corridors of power who would usually prefer corporate hospitals. But the treatment of a close relative of a senior IAS Officer in a government establishment will not be the same as what a common man can expect or even dream of.
This piece is about the common man. And what ordinary people go through when they visit hospitals. A few days ago, my personal driver Narayanan became a grand-father. Just like me, his son was blessed with twin babies - a girl and a boy. It was a premature delivery; two full months ahead of the due date. And how did the gynaecologist, who refers cases to a hospital run by a trust, treat this case? Quite simply, by not turning up for the delivery! Why? Because, she allegedly prefers to do only caesarean operations, possibly for a fee. This is what the patient heard.
The divine hand ensured that it was a normal delivery and the staff nurses managed on their own. But as the premature babies weighed just 1.2 and 1.8 kgs, they had to be rushed to a neo natal ICU at the closest hospital, which happened to be a corporate entity. This is where my babies were also born and I can vouch for the dedication of the doctors and nurses there. To keep the two babies in an incubator, the estimated cost was nearly twenty thousand rupees a day. That's twice the monthly salary of my driver.
The young father Bharath is an employee of a software company. I had got him placed there through a friend who owned the company but later sold his stake. The magic mediclaim wand was flashed. Cashless hospitalisation that glib talking agents promise often proves to be a misnomer. The family had to cough up an advance of twenty thousand rupees for the admission of the two precious babies. Under a legitimate belief that the bill would be covered by the mediclaim policy, the parents decided to give the new born babies the best possible treatment.
Four days on, there is a bombshell. The mediclaim scheme they were under, was valid only for the employee and 3 family members, who at the time of signing up, were his wife and his parents. The option of replacing the parents' names with the children in the womb had not been exercised as it was a two month premature delivery. My driver tried to seek a clarification from the insurance agent who was downright rude and banged the phone down. I spoke to the Chief Operating Officer of the third party administrator (TPA) and sought her intervention for this deserving case. I had a word with the HR Manager of the employee in question, who advised the young father to mail a request to replace his parents' names with the infants. I had a chat with the paediatrician at the private hospital whose colleague was treating the babies and they were kind enough to reduce their fee. But the ICU bill was close to sixty thousand rupees and counting. The TPA chief expressed her helplessness as the infants were not covered and they would be eligible only two days after the request to include their names was received. That would push up the bill to close to a lakh; money that would not be reimbursed. And there was no indication of how long the hospitalisation would last. The family decided to shift the infants to a smaller hospital and cough up the bill of about sixty thousand.
I have questions for our insurance companies, for the Insurance Regulatory & Development Authority, for Third Party Administrators, for insurance agents, for hospitals, for doctors, for HR departments, for the government:
Why are unborn children not automatically covered by default in all mediclaim policies, at least of those holders under 30?
Shouldn't unborn children have the right to the best treatment under every existing policy?
What do insurance companies mean by cashless hospitalisation?
Why is their mind-set anti patient, anti claim and pro exclusion clauses?
Why do insurance agents think their job is only to collect fat commissions and make themselves scarce when they are really needed?
Why do hospitals almost always insist on advance payment?
Aren't stated and brazen preferences for C-Section surgeries against medical ethics?
Why do HR departments think their job is only to hire and fire and do assessments and the odd team bonding stuff? What about flagging and anticipating such situations earlier?
How did the government allow insurance companies to have a slew of exclusions hemmed into their policies that are clearly detrimental to public interest? And fairplay? And ground realities?
Why do VVIPs in other countries prefer government hospitals unlike India, where bigwigs troop to the best private hospitals abroad for treatment?
Should the fine print in a medical insurance policy be more important than the bottom line: to bail us out in an emergency?
I'm sure many of you reading this have the same questions in mind. Feel free to add more. For now, I speak for the two four-day-old infants being moved out from one neo natal ICU to another. They would probably like to tell the insurance company: "You Ignored Our Very First Cry."How You Can Help:
Readers who wish to help the twin babies can send cheques or deposit money in the bank account of the father:P. BHARATH,
48, Perumal Koil Lane,
Chennai - 600 085.
Mobile No. 9551139165
HDFC BANK, KARAPAKKAM, CHENNAI - 600 097
A\C NO. 18521140000240
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