Thread by @DeepakRKhemani

This is borderline fraud by #Health and General #insurance companies in #India
The Misuse of "The Reasonable and Customary Clause" in #HealthInsurance
A Thread 🧵
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👇

We all know that health insurance is crucial, but a concerning trend has re-emerged post the pandemic in India. Insurance companies are back to misusing the "reasonable and customary clause" to reduce reimbursement claims, leaving ordinary people in a difficult situation.
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🏥 Understanding the "Reasonable and Customary Clause"

The clause sets the maximum amount an insurance company will reimburse for medical procedures. It aims to prevent overcharging. However, some companies are misusing this provision

Let me share 2 recent cases
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In one a private health insurer has declined to pay 2 laks from a total claim of 2.90 lakh for a surgery using the Reasonable and Customary clause without assigning any logic for the same except that the Surgeon and Assistant Surgeon charges are inflated and we will not pay.
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In case of PSU General Insurer of a total bill of 2.87 lakh 1.20 lakh has been deducted under various heads as reasonable and customary charges.
Again it's Mainly Surgeon and Assistant Surgeon charges.
Both policies are 10+ years old and there's never been any claim before
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Insurance Companies' Manipulation

These companies are using old and low benchmarks for determining "reasonable and customary" charges, falling below actual costs. Policyholders face significant out-of-pocket expenses, burdening them further with medical costs
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🚫 Negative Impact on Ordinary People

The consequences are grave. Ordinary people are forced to bear a substantial portion of treatment costs, sometimes unable to afford necessary care. Their health and well-being are compromised.
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⚖️ We must fight for fair and transparent practices by insurance companies. Realistic benchmarks reflecting actual costs should be used. Policyholders should not be unfairly burdened.
Regulators must come in and prevent this loot that's happening by misuse of this provision
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📢 Raising Awareness and Demanding Change

Raising awareness about this issue is crucial. Insurance companies must change their practices. Transparent pricing and fair reimbursement policies are needed to ensure access to medical care without financial hardships.
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💡 Policyholders should understand their rights and scrutinize insurance policies. Reading the fine print and seeking clarification will help them make informed decisions and protect their interests. An experienced advisor is invaluable in such situations.
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💪 Strengthening Consumer Protection

Government bodies and regulatory authorities need to step in to protect consumers. Stricter guidelines, monitoring, and penalties for non-compliance can deter insurance companies from exploiting the "reasonable and customary clause."
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🌐 Learning from International Practices

India can learn from other countries' experiences. Studying how they regulate insurance practices and protect policyholders can provide insights into improving the system and preventing misuse.
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🌟 A Call to Action

Let's join hands to bring about a positive change. Through awareness, and demanding fair practices, we can ensure health insurance truly serves its purpose of providing financial protection in times of medical need.
What say @themahavir @BeshakIN
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