Sunday, November 11, 2012

Why health insurance companies need to promote health literacy

Patients buy health insurance because they understand that costs of health care are rising and they need to protect themselves if they fall ill. Most assume that if they have medical insurance they are going to be able to afford medical care if they need it. Sadly, this is not always true. When you buy a health insurance policy, the friendly company agent is very happy to come to your house, take your signature on the health insurance form, and collect your premium. The company will also faithfully send you annual reminders for your premium payments. However, when it’s time to submit your claim for reimbursement of medical expenses, things can get quite hairy. The processes at health insurance companies seem to be designed to reject as many claims as possible, no matter how legitimate they maybe. This is hardly surprising, because health insurance companies are profit-making, and the longer they can hold on to your premiums (their “float”), the more money they stand to make.

It is only when your claim gets rejected that you start to carefully study the health insurance form you signed many moons ago. You find it is full of baffling terms, including “exclusions”, “co-payments”, “deductibles “, “pre-existing conditions”, and "usual, customary, and reasonable charges" – terms that sounds like Greek and Latin and which your agent never bothered to explain when collecting the premium. Insurers seem to be deliberately keeping their customers in the dark by burying all the exclusion clauses in masses of fine print. The reason they do this is simple – it’s all about money. The forms are designed to purposely obfuscate: to make the claim process so difficult that people give up on pursuing their claims, even if they are valid, because they cannot cope with the hurdles the insurance company places in their path. This is hardly surprising, since the forms are designed by health insurance company lawyers, to protect the interests of the health insurance company.

Make sure you disclose everything that is required in the form - please do not sign a blank form and leave it to the agent to fill the form later. If you do not disclose a pre-existing disease then you run the risk of your policy being cancelled or a renewal being denied if this fact is discovered later. Keep a copy of all documents submitted to the insurance company for your future reference and remember that any promise made by the agent or even an official of the insurance company has no value unless it is in writing.

The US government has now taken concrete steps to ensure that patients can make sense of what their policy covers and what it does not. The Affordable Care Act – the new health reform law – requires health insurers to provide concise and comprehensible information about health plan benefits and coverage. In India, patients are much more vulnerable and the Consumer Dispute Redressal Forums are log-jammed with unhappy and angry patients who feel cheated because their insurance company has refused to pay claims on all kinds of flimsy pretexts.

HELP is organizing a conference on “ Putting Patients First Through Health Literacy  “. This will be on Sunday, 2nd December’12 at Nehru Center at 10.30a.m. to 1.p.m.  The website is

The conference will be followed by a health literacy workshop in the afternoon. Helen Osborne, President, Health Literacy, a world renowned  Consultant from US , will be delivering the keynote and conducting the workshop.  Her website is at

At this time, we will be releasing the book, Deciphering Medical Gobbledygook: Promoting Health Literacy to Put Patients First , authored by Dr Aniruddha Malpani and Juliette Siegfried. This is a section from that book

1 comment:

  1. Health is the basic criteria for staying happy. However, many ignore their health, and don’t buy insurance coverage, so that they don’t have to bear the costs of the premiums. However, staying uninsured is not sensible. What if you fall ill? Who will bear the cost of the treatments? Obamacare has made health insurance mandatory for the US citizens. This approach will raise awareness amongst the people. The best benefit that the new mandate promises is that people with pre-existing conditions will be able to buy health insurance protection more comfortably, since the insurers won’t be able to deny coverage anymore.


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