On a family holiday in Switzerland in May, a father's worst nightmare came true.
On a Friday afternoon my son had acute pain in his abdomen, the general practitioner whom we consulted advised us to rush to a hospital. At the hospital he was advised to undergo an emergency appendicitis removal operation. We were apprehensive as we were in a strange country and even communication with some of the doctors was a little challenging as some of them could not speak English fluently. In the late evening after considering the risks of not operating we gave our consent for the operation.
We could afford to pay for the operation on our own but at the back of my mind was a question whether the insurance company (my travel insurance policy was taken from a public sector insurance company) would actually pay up. The policy was part of a package taken through the tour operator who had made the travel arrangements for us. He in turn had used the services of an insurance broker to buy the package policy.
Here is my experience described in greater detail:
Friday, May 23: My son got operated at around 10 pm. He was admitted and operated without us having to fill in an admission form or making any deposit. They did not even know whether we had insurance to cover the costs.
Late at night I sent an email to the international TPA, the Indian TPA and the Indian insurance broker informing them of our impending claim.
Saturday, May 24: My son was fine and so started to try and call for activating the claim process. The initial call to the Paris toll-free number was not very fruitful with the male consultant on the other end of the line not giving any satisfactory response. But when I checked my email I had received a response from them indicating a file number for my claim and laying down the documents needed to process the claim.
I also reached a very helpful gentleman called Prakash who was the claims executive with the insurance broker in India. He made several calls to me and also spoke to the TPA in Paris and generally guided me. The hospital was also helpful and provided the necessary facility for faxing the papers to the Paris TPA. However a confirmation from the TPA to the hospital got stuck because they wanted a medical report from the hospital before providing a coverage confirmation (which would have enabled me to avail of cashless facility from the hospital).
The hospital informed me that this was not a usual request and it took a couple of hours before I could get the report and fax it to the Paris TPA. Meanwhile since it was a Saturday I was forced to make a deposit (around Rs. 125,000) to the hospital by using my credit card. While we received no final confirmation from the Paris TPA the Indian TPA had not responded at all.
Sunday, May 25: My son was discharged from the hospital.
The hospital said the deposit was enough to cover the bill and they would refund the balance in due course by crediting the balance to my credit card account. No final confirmations from the Paris TPA, though I must say that by then a very competent lady from the Paris TPA kept calling me to update me on what was happening. She also informed me that she had sent a confirmatory fax to the hospital (this was after the discharge) and as the hospital office was closed we could not confirm the receipt of the fax by them.
Monday, May 26: The hospital confirmed that they had received the fax confirmation from the Paris TPA and would refund the entire deposit amount to my credit card in a few days time after they actually receive the payment from the insurance company. Prakash had been in touch with me through out.
Tuesday, May 27: We return to India.
First week of June: Submitted a claim for expenses paid for the general practitioner in Switzerland, the ambulance charges, and the medicines purchased amounting to about Rs 25,000. This was submitted to the Indian TPA through Prakash.
Second week of June: Got the Switzerland hospital deposit amount refunded in my credit card account. Was shocked to discover that even though in Swiss franc terms I had received the full refund, there was a difference of around Rs. 13,000 in the rupee amount that I had paid and the rupee amount credited to my credit card account. On closer inspection it proved to be because of the huge 3.5 per cent each way commission that the credit card company charges (making it 7 per cent in all) as well as the significant differential in the buying and selling rate of the foreign exchange.
Meanwhile Prakash informed me that my other claim had been approved on June 13 and I could expect the payment cheque in 15 days time.
July 2008: No cheque despite vigorous follow up. Finally in the last week of July sent an e-mail notice to the insurance company that I would complain to the Insurance Ombudsman if I did not receive the payment.
August 4, 2008: Finally I receive the cheque by courier.
My learnings from the whole episode:
1. Never pay by credit card overseas. Only the card issuer goes laughing all the way to the bank.
2. The Indian insurance companies have specific requirements that make the process of pre-approval that much more difficult overseas as it is not in line with local practices.
3. The moment you submit claims to the Indian TPA brace yourself for delays.
4. Use the two magic words 'Insurance Ombudsman' in your letters and e-mails. That's the one thing that makes the wheels move.
5. The insurance broker is worth his weight in gold if they have people like Prakash working for them.
6. While the delays were annoying and the amount retained by the credit card company was scandalous, I don't think I will ever venture outside Indian shores without a proper travel insurance policy.
7. If you have to fall ill do so in a country like Switzerland, where even the general ward is better than the luxury suites of Indian hospitals. The nursing staff actually helped us in booking a hotel for the night and summoned a taxi for us. A level of service that I cannot even imagine in India.