@KPNarayanan1 No voted for the mayor and his party? So Rajesh who helped him without looking at this guys party color became a Sasi. Rajesh should have treated such people like dogs
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How health insurers cheat patients and doctors
*Dr. Neeraj Rayate*
Why so many insurance companies are shamelessly notorious for denying even valid claims?
And who decides what surgery was performed?
A team of surgeons who spent their lives on their skills or a tip-toed MBA with a spreadsheet at an insurance company?
A few days ago, I operated on a patient with a recurrent abdominal wall infection.
It wouldn’t heal... antibiotics weren’t working and the infection kept coming back.
I diagnosed it as an atypical mycobacterial infection.
Our team at Jupiter Hospital, along with Dr. Soman sir, an infectious disease expert, treated him completely.
He is now cured.
And then came the shock.
At discharge, his insurance company denied his claim.
Why?
Because, according to them, the “procedure claimed was incorrect.”
Now let’s pause for a moment and ask:
Whose word should matter?
The team of surgeons and specialists who actually examined, diagnosed, and performed the surgery?
Or an insurance company that never saw the patient, never looked at the wound, never made the incision, and never fought to save his health?
Yet they had the power to decide whether his treatment was “valid.”
This is not an isolated case.
I see this happen every day at our hospital.
Insurance companies deny even valid claims as if it’s routine.
The treatment is needed... surgery is done... patient is recovering.
But then, some desk-bound approver, armed with a checklist, decides otherwise.
And do you know why?
Because, for most of these companies, denial is biggest part of their business model.
Let’s call it what it is.
Many insurance companies profit by saying NO.
Denial is money saved... delay earns them interest and every loophole increases their profit margins.
And they know exactly what they’re doing.
They reject claims on technicalities hoping the patient won’t fight back.
They stall payments until hospitals, desperate for cash flow, are forced to write off part of the bill.
They use vague policy wording so they can interpret it however they want.
They drown patients in paperwork, making it so exhausting that many just give up.
Meanwhile, the patient’s family is left feeling helpless, wondering how they will pay.
And when they try to reach out to the insurance company?
No one picks up the call, emails are ignored and multiple rounds of appeals lead nowhere.
And the worst part?
There is no punishment for them.
If a patient doesn’t pay their premium, the policy is canceled.
But if an insurance company denies a valid claim?
Nothing happens.
They face zero consequences for ruining lives.
This needs to CHANGE.
The government must step in... strictly.
Insurance companies should be regulated and held accountable.
Here’s what I feel should happen.
Independent review board – Patients should be able to appeal to a neutral authority, not the same insurance company that denied them.
Heavy fines for wrongful denials – If an insurance company denies a legitimate claim, they should pay for it—literally.
Burden of proof on insurance companies – Right now, patients have to prove they deserve their claim. That should flip. Insurance companies should be forced to provide solid proof before rejecting a claim.
Clearer policies – No more vague wording. Policies should be transparent about what’s covered and what’s not.
Strict limits on claim denials – If a company rejects too many claims, they should be investigated for fraud.
Seriously, I see patients suffer even after paying premiums for 5, 10, or even 15+ years.
It’s high time we have to raise the voice.
I’ll keep writing about these incidents with a hope that someday things will be better for patients.
What are your experiences and thoughts? Will like to understand.
#Insurance
#Mediclaim
#Healthcare