Health Insurance Hassles: Patients Speak Out On Delays, Excuses, And Denials

Health insurance is meant to ease financial stress during medical emergencies, but many policyholders find themselves fighting their insurers instead. One of the most common tricks insurers use is to reject claims by pointing to an old illness, even if it has nothing to do with the current treatment. Say you’re hospitalised for a fracture—they might still dig up a past case of diabetes and say it wasn’t disclosed.

Another unfair tactic is misreading the fine print. Insurers sometimes label genuine treatments as “optional” or “not necessary,” ignoring your doctor’s advice altogether. It’s also not uncommon for them to delay asking for documents until the deadline to submit them has passed—then they simply reject the claim, saying it was “incomplete” or “late.”

Some insurers even rely on internal rules they’ve never shared with customers. Sometimes, people are forced to accept a lower payout to avoid delays. Even when the hospitals are within the network, cashless payments may be delayed so that customers are forced to pay upfront.

As an example, Kolkata-based Pramathesh Sen, 70, recently had eye surgery. He put in a claim with his health insurer, a policy he shared with his wife, Indrani. What came next was a months-long headache: the Chennai-based company kept changing what they needed, constantly asked for more papers, and barely bothered to talk to him.

“The insurer initially rejected my claim, citing non-disclosure of diabetes,” Sen explains. “But I had declared it. And in any case, my diabetes was under control and unrelated to the eye surgery—something my doctor confirmed in writing.”

Even after this clarification, it took two months for the insurer to acknowledge his claim. But the delay didn’t end there. “They then raised an issue with the cancelled cheque, saying it was not in the main policyholder’s name, even though it was a joint account,” Sen adds. After several follow-ups, he was told the claim had been disbursed, only to later learn that the money had gone to someone else entirely.

“When I questioned them, they sent me a screenshot of a different person who had received Rs 5 lakh, claiming it was me,” Sen says. “Only after I protested did they admit there was a mix-up and asked me to send a declaration form clarifying my relationship with my wife.”

Despite multiple calls and documentation over four months, Sen still hasn’t received the reimbursement. Recently, they have again asked him to send a letter of declaration which clarifies his relationship with his wife, as it was a cancelled cheque with a joint account. “It feels like they are deliberately making the process confusing, hoping you give up. It’s exhausting.”

In another example, Sunita Deshpande, a 61-year-old from Bangalore, had her knee replacement surgery done at a reputed private hospital. Since it wasn’t part of her insurer’s cashless network, she filed for reimbursement. She sent in all her documents within the required timeline—bills, discharge summaries, prescriptions, everything. But weeks went by with no update. Then, the insurer asked for the discharge summary again. Later, they wanted the implant invoice separately. After that, they raised a query about the doctor’s handwriting on the prescription. Her son spent hours writing emails and calling customer care. The claim—Rs 2.4 lakh—finally came after four and a half months.

If such things happen, you should first complain to the insurance company, and if you still do not get a resolution, you should approach the insurance ombudsman.