Insurance companies are only interested in people till the time they join the insurance plans. After joining their main goal is finding reasons on how not to pay their insurance claim. If possible, they will also look at the strategy of prolonging it as much as possible. Medical expense insurance coverage plans are spread all over the country today and are subscribed to by lakhs of people. Many terms and conditions have to be passed to get back the amount spent in the hospital.

A hospital stay of at least one day is mandatory. The insurance company will accept the medical bill, only after hospitalization according to this. However, as an exception to this, a ruling by the Ernakulam District Consumer Disputes Redressal Commission has given hope to members of medical insurance schemes. John Milton, a resident of Ernakulam Maradu, filed a petition with the Consumer Disputes Redressal Commission to get an insurance claim on the hospital bill related to his mother's eye treatment.

Milton's mother, who underwent eye surgery, had left the hospital that same day. The insurance company did not accept the hospital bill on the grounds that there was no 24-hour hospital stay. The petitioner approached the Dispute Resolution Commission after the claim was rejected. In this day and age of advanced techniques in eye care, only a few hours are needed to be spent in the hospital after the surgery. Moreover, many insurance companies cover the cost of eye surgery such as cataracts without requiring hospitalization.

The company rejected Milton's claim without considering any of this. The decision of the commission is that the 24-hour requirement of the insurance company is not relevant if the treatment and rest are completed in less than 24 hours. It is also directed to pay Rs.57,720 to the petitioner within thirty days. The claim was submitted for half of this amount. The company will have to pay double the amount due to sticking to the 24-hour hospital stay requirement.

Most of the companies claim that their medical policies are cashless. However, the situation is that if one has to go home after treatment at the hospital, he has to carry a pocket full of money. Many of the items included in the bill will be rejected by company representatives. If you get a claim for at least half of the original bill after all the calculations are done, you're lucky.

The Insurance Regulatory Authority is meant to prevent fraud by insurance companies. The advantage of companies is that very few policyholders come forward to lodge complaints. Even the government's insurance scheme like MEDISEP is not beneficial to the government employees, because of the excessive profit hunger of the insurance companies. Public sector organizations are also at the forefront of rejecting fair claims to policyholders with an approach that reminds people of Shylock.