As a victim of this scam, I can attest to it.
KIMS Begumpet Doctor discharged me at 11 AM.
@HDFCERGOGIC paid 33% of the bill.
After multiple calls and escalations, all from my hospital bed in my post operative pain I gave up. I paid the difference and went home at 7 PM.
After much drama, HDFC reimbursed me a month later.
I feel it’s better off, putting some money aside for a surgery, than subject yourself to this torture and indignation.
Cashless health insurance is legally sanctioned house arrest.
The doctor officially discharges you at 9 AM. You are fully recovered, your bags are packed and your family is ready to take you home.
Then the hospital administration steps in: "Sir, the insurance TPA approval is pending. Please remain seated in your room until we receive the final payment."
You then spend the next 8 to 12 hours held hostage in a ₹15,000-a-day hospital room.
You are no longer a patient but you are collateral. The hospital doesn't trust the insurance company to actually pay, the insurer is deliberately stalling to find a typo in your medical history to reject the claim and you are stuck in the middle of a corporate standoff.
We live in a country where UPI settles transactions in 300 milliseconds and automated trading algorithms move crores in a microsecond.
The system is designed to exhaust you. They want you so frustrated and desperate to go home that the next time you get sick, you just pay the cash upfront and file for a reimbursement which they will conveniently reject 45 days later citing "insufficient documentation."
If my policy is active and the hospital is in-network, the final discharge should be an instant and automated API settlement. Man I paid insurance company for this service.
Until we force insurers to adopt automated clearing, stop calling it a cashless facility.
Call it what it actually is: an extortion racket with a waiting room.