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Regarding Active line of treatment

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21 Sep, 2022 by  harivansh agrawal

As I do get a health insurance claim there should be an active line of treatment but what happens if a person is in a coma or something like that there is no active line of treatment in this case but hospitalization is needed to keep him alive but even after keeping him in the hospitals his conditions are not improving will insurance company will cover the expenses even though there is no active line of treatment there?

since they are just monitoring the conditions


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21 Sep, 2022
CEO, Insurance Samadhan

Dear Harivansh

Very interesting question and I also sought the answer from Experts of insurance company.

Feedback is given below :

Cliam will be given till patient is under treatment or on hospital support .

But if it require only an observation then claim will not be paid and patient need to be cared at home .

If any one has different opinion then please share .


Generally , I have answer of questions but I could not give convincing answer.


Best wishes


Shailesh Kumar

Insurance Samadhan



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22 Sep, 2022
Founder, Beshak

Hello Harivansh,


Great question. Thanks for asking.


You are right insurers will pay only for active treatment - not for prevention, not for monitoring - only for a cure.


In fact, many insurance plans have a clear exclusion in their policy wording for artificial life maintenance, where the person is brain dead or in a "vegetative" state.


The usual rule is "Will the patient ever get cured and be better off, because of the treatment being carried out" If the answer is no - then most insurers won't cover these expenses.


In the instance, you have shared, in my opinion, if it is clear that the conditions of the patient are not going to improve - insurers won't cover the expenses of that duration.


Hope this was useful.


Mahavir

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22 Sep, 2022
harivansh agrawal
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