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Question regarding a Hypothetical Scenario ?

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30 Sep, 2022 by  harivansh agrawal

I was watching HOUSE M.D. now in that series there is a character named Dr House so in this, he will diagnose a disease which no one was able to. for that, He recommends several tests (by elimination method) he tries to figure out what is wrong with that patient and there is no active line of treatment going on here so I know the insurance company will not pay for this but what happens if the disease is diagnosed will the insurance company will pay for the tests which are not related to this final disease which had diagnosed


suppose he ordered a brain MRI, thyroid and what not.. but in the end, the disease was found in the kidney will the insurance company pay for the Brain MRI, thyroid which is not related

Or they will pay for the test which is related to kidneys only


I know my example is weird and


sorry for the weird question :)


but it can happen, doctor, recommend a test which is entirely unrelated to the final disease

and the insurance company will pay for those test

If there is treatment...after a whole lot of diagnosis





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Medical diagnosis isn't a straight line & your assumption is more fiction over reality at best, insurer is bound to pay for hospitalization upto discharge regardless of the outcome of the treatment as it denotes an earnest attempt by the medical team to identify and cure the underlying ailment.


PS : A big fan of House MD myself 😁

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02 Oct, 2022
harivansh agrawal
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04 Oct, 2022
CEO, Insurance Samadhan

Dear Mr Agrawal

Answer may be controversial but based on wisdom of experience .

In this case client will be paid as per the limit of annual health checkup if ypur policy has a provision of annual health check up .

Generally limit is Rs 4000 per annum , hence irrespective of amount spent client will be paid rs 4000 only .

Willing to accept any comments .


Shailesh Kumar

Insurance samadhan

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04 Oct, 2022
harivansh agrawal
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