Question regarding a Hypothetical Scenario ?

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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2 Answer

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01 Oct, 2022

Pankaj Singh Yadav

4.7

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 😁

2 Comments

02 Oct, 2022

harivansh agrawal

I know my question is frictional that's why I have written Hypothetical, although the diagnosis is not a straight line treatment, so ( some times diagnosis is also in a straight line for you present a symptom you get to recommend a diagnosis you present new symptom you again gets new tests)

Just try to ask will the insurance company will pay for the entire test or just to test which are related to the final disease which had been diagnosed

Which is yes from your side if I am not wrong

02 Oct, 2022

Pankaj Singh Yadav

4.7

Yes

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04 Oct, 2022

Shailesh Kumar

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

1 Comments

04 Oct, 2022

harivansh agrawal

Sorry, I think you have misunderstood the question it is not about the Annual Health Checkup. There is something inherently wrong with the patient and the doctor is recommending test after test trying to find what is wrong with the patient finally able to find out that the patient had that particular disease and there will be an active line of treatment after the diagnosis, in that case, will the insurance company pay for the test or just the test that is related to that specific disease?

I always think that it, is not part of an annual health check-up as this is not preventive in nature, generally, yearly health checkups are given as a reward for no claim or as a preventive test but in this case, there is an underlying disease and we are trying to find what disease ...

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Question regarding a Hypothetical Scenario ?

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