Hi there! I’m a Dr.Divyprakash, MD physician. I have treated several patients who are not covered by health insurance and they struggle to afford proper treatment.
In this busy world, we have also learned where to get health insurance and how to claim it. Everything is available at the fingertips right in front, I agree!
Because of this health insurance apps have become really popular. But, never believe in the idea that apps are gonna be the one stop solution for all your problems.
Let me take you on a journey—a story that begins with two of my patients, Arjun and Neha, and ends with some important lessons every individual should consider before making a decision to use a health insurance app.
Arjun and Neha: A Tale of Two Policies
I’m introducing you to two separate individuals with two separate lives, one is Arjun aged 28 who works as a professional in the tech industry, and keen about his physical health. Arjun has said goodbye to paperwork and has stored all of his health insurance related data in a simple to use app.
Unfortunately for him he had to face a different scenario: an injury from a game. Which made him panic and question if the insurance would take care of him in this case as he would have thought.
So he decided to use the two features which he’s been bragging about: user-friendly interface and claim submission.
Sad cringe, he was told that the insurance suggested only covered pro sports professionals, unfortunate news if you ask me.
Coming at the second individual, Neha, she only struggles with asthma, but she’s on a constant watch as she has 34 YRS old waiting for all the checkups.
She became interested in another app’s feature that allowed her to make cashless claims but later on found out that the network hospitals enlisted in the app had changed, and she was to funded herself.
The experiences of both Arjun and Neha bring forth an underlying problem which is, we as healthcare insurance consumers tend to be seduced by these apps in which the policy looks oversimplified but in reality, crucial information is hidden.
What Are The Disadvantages Of Getting Health Insurance?
As much as I like to believe otherwise, not all health insurance apps work the same. I’ve been a physician long enough to have assisted several patients who were left distraught when they discovered the financial repercussions due to omissions or misstatements in the policy or application. Here is a list of things that you should be careful about:
1. Exclusions that are not Sufficiently Disclosed: Some apps may not highlight particular exclusions from the policies such as mental health care coverage and for instance, pre-existing conditions.
2. Policy Terms That Are Not Straightforward: Sometimes difficult questions or terms such as “reasonable and customary charges” can unduly limit the amount of the claim made. App providers are always careless in addressing the information.
3. Low Premium Misrepresentation: Users are often shown various applications with very low premiums and are left with high co pay or high deductibles that were not indicated.
4. Biased Partnered Policies: Certain apps only show policies of insurers that have partnered with them which renders a skewed view to the consumers.
5. Claim’s process isn’t done well enough: There is a variety of documentation and the steps that are required for claims, many features in the app restrict it which leads to the documents being either delayed or not sent at all.
The Fraud: Red Flags
It is a known fact that some businesses engage in fraud in order to increase their income. Here is how to spot them.
Bait-and-Switch Tactics: The advertisement offers a low premium only to fail to provide essential coverage in the fine print.
Inconsistent Policy Updates: The users of apps are not informed, but in the middle of the policy an insurer changes the terms such as the hospitals within the network or the treatments that are covered.
Overcomplicated Terms: This is known as jargons that are meant for consumers to be confused.
Claim Rejections on Technicalities: Documents that are required to provide a supporting proof contain minor errors or steps that were not followed resulting in a denial.
How to Avoid These Scams: Guidelines for Using Health Insurance Applications
1. Check the Entire Document: Even if the app specifies a summary, it is important to download and read the entire policy document.
2. Network Hospitals Check: Check that the network’s listed hospitals on the app are right and frequently updated.
3. Inquire: Call customer support to ask about the policy details regarding the exclusions and how to make a claim.
4. Look at Factors Other Than Price: Study co-pays, sub-limits and claim settlement ratios.
5. Read User Feedbacks: User reviews can have information about applications not working as intended including claim delay or lack of assistance and support from the platform.
I encourage you to exercise caution while using health insurance apps. They are however a source of convenience, so there is need for carefulness on your part. One such cover can serve as a shield from such financial instability.
Save This Health Insurance Table:Made for You Only
1. Chronic Diseases or Long-Term Care Needs
If you have chronic illnesses like diabetes, hypertension, or asthma:
| Feature | Why It Matters | Tick the Box |
|---|---|---|
| Chronic Disease Coverage | Many policies don’t cover chronic illnesses from day one. Look for early coverage. | ✅ Ensure the app explicitly mentions diseases covered and any waiting periods for pre-existing conditions. |
| Annual Health Checkups | Regular health checkups can reduce out-of-pocket expenses. | ✅ Confirm free annual health checkups are included. |
| No Claim Bonus (NCB) | Rewards for staying healthy despite chronic conditions. | ✅ Opt for policies offering NCB to reduce premiums over time. |
| Cashless Claims | Quick access to care without upfront payment. | ✅ Ensure listed network hospitals match your regular treatment centers. |
2. Maternity and Newborn Care
If you’re planning a family or expecting a child:
| Feature | Why It Matters | Tick the Box |
|---|---|---|
| Maternity Coverage | Covers delivery expenses, including cesarean sections. | ✅ Look for policies with a reasonable waiting period (e.g., 1–2 years). |
| Newborn Baby Coverage | Includes vaccinations, neonatal care, and illnesses. | ✅ Verify that newborn care starts from day one and check coverage limits. |
| Room Rent Limit | Higher room rent allowances can prevent out-of-pocket costs. | ✅ Choose a plan with flexible or no room rent cap. |
| Fertility Treatment Add-ons | Some policies include coverage for infertility treatments. | ✅ Ensure these are explicitly stated in the app’s policy details. |
3. Senior Citizens or Elderly Care
For parents or individuals over 60:
| Feature | Why It Matters | Tick the Box |
|---|---|---|
| No Co-Pay | Senior-friendly plans avoid partial payment of claims by policyholders. | ✅ Opt for policies with no or minimal co-pay. |
| Coverage for Pre-Existing Diseases | Many seniors have health conditions requiring immediate coverage. | ✅ Confirm pre-existing diseases are covered after a short waiting period. |
| Daycare Procedures | Covers surgeries and treatments requiring less than 24-hour hospitalization. | ✅ Ensure common procedures like cataract or dialysis are covered. |
| Domiciliary Care | Allows treatments at home when hospitalization isn’t possible. | ✅ Verify that domiciliary treatments are covered. |
4. Families with Young Children
If you’re looking for family floater policies for young children:
| Feature | Why It Matters | Tick the Box |
|---|---|---|
| Family Floater Plans | Covers all family members under a single policy. | ✅ Check the app for maximum coverage for all dependents, including children. |
| Vaccination Costs | Reduces out-of-pocket expenses for immunizations. | ✅ Ensure vaccinations for children are covered. |
| OPD (Outpatient Department) | Covers doctor consultations and minor treatments without hospitalization. | ✅ Look for OPD coverage for routine visits and minor illnesses. |
| Critical Illness Add-ons | Covers rare or severe illnesses like congenital diseases. | ✅ Confirm if the app allows adding critical illness coverage for children. |
5. Frequent Travelers
For professionals or families frequently traveling domestically or internationally:
| Feature | Why It Matters | Tick the Box |
|---|---|---|
| Worldwide Coverage | Covers medical expenses during international travel. | ✅ Ensure that policies include emergency care abroad with no major exclusions. |
| Emergency Evacuation | Covers air ambulances or medical evacuations if needed. | ✅ Confirm if emergency evacuations are explicitly included in the policy. |
| Cashless Treatment Abroad | Avoids upfront payments in foreign hospitals. | ✅ Check for a global hospital network in the app. |
| Lost Documents Assistance | Helps recover lost insurance documents while traveling. | ✅ Verify if the app provides features like digital document backups. |
6. High-Risk Jobs or Hobbies
For individuals engaged in high-risk professions or activities (e.g., construction, adventure sports):
| Feature | Why It Matters | Tick the Box |
|---|---|---|
| Accidental Coverage | Covers injuries from workplace accidents or extreme sports. | ✅ Check if accidental injuries are covered, even for high-risk hobbies like trekking or skiing. |
| Permanent Disability Benefit | Offers financial support if you can no longer work due to injuries. | ✅ Confirm the app includes this benefit for accidental disabilities. |
| Critical Illness Add-ons | Covers illnesses triggered by high-stress environments. | ✅ Look for critical illness add-ons explicitly covering work-related diseases. |
| Life Insurance Integration | Combines life and health insurance for comprehensive coverage. | ✅ Check for bundled plans with accident-specific death benefits. |
7. Mental Health Care
For individuals seeking psychological or psychiatric support:
| Feature | Why It Matters | Tick the Box |
|---|---|---|
| Mental Health Coverage | Covers therapy, counseling, and psychiatric treatments. | ✅ Ensure mental health treatments are included, not excluded in fine print. |
| OPD Coverage for Therapy | Covers outpatient visits for counseling sessions. | ✅ Verify if policies explicitly cover therapy under OPD benefits. |
| Rehabilitation Programs | Covers addiction recovery programs and long-term counseling. | ✅ Check if rehabilitation programs are included under coverage. |
| Stress-Related Illness Coverage | Includes diseases linked to mental health, like ulcers or hypertension. | ✅ Confirm if the policy covers stress-related physical illnesses. |
8. Cancer or Critical Illness Risk
For individuals with a family history of severe illnesses like cancer, stroke, or heart disease:
| Feature | Why It Matters | Tick the Box |
|---|---|---|
| Critical Illness Add-ons | Offers a lump sum for diagnosis of critical conditions. | ✅ Ensure illnesses like cancer, heart disease, or organ failure are included. |
| High Sum Insured | These treatments are costly, so higher coverage is essential. | ✅ Opt for policies offering higher sums insured for critical illnesses. |
| Post-Treatment Care | Covers rehabilitation and follow-up expenses. | ✅ Check if post-treatment care, like physiotherapy, is included. |
| No Sub-Limits | Avoids coverage caps for expensive treatments like chemotherapy. | ✅ Ensure there are no sub-limits for specific treatments. |
Pro Tip For You
When using health insurance apps, look beyond the interface. Download the full policy document and compare these characteristics to your individual health requirements. Remember that the correct health insurance is about protecting your future, not just cutting costs.
The Physician’s Perspective
As a physician, I advise you to use health insurance apps with caution. While they provide convenience, they also require monitoring. Choosing the correct health insurance might make the difference in financial stability and disaster after a medical catastrophe.
Always remember that attractive interfaces and low prices do not equal complete coverage. So, whether you’re Arjun, Neha, or someone altogether different, take the time to comprehend your health insurance policy.
Use applications as a tool, but do not allow them to make decisions for you. At the end of the day, your health is invaluable, and no app should determine how you safeguard it.
What is your experience using health insurance apps?
Did they assist or hamper you?
Please let me know in the comments below.
Reference
When exploring the complexities of health insurance apps and policies, several high-quality research references provide valuable insights:
