The rate of rejection of medical insurance claims under the Rashtriya Swasthya Bima Yojana (RSBY) is on the rise in the district. The RSBY is a scheme for the unorganised sector labourers in the country. A maximum of five members of a family in the Below the Poverty Line category can avail themselves of in-patient treatment benefit for up to Rs.30,000 a year through empanelled hospitals under this scheme.
G. Sukumaran, Professor of Medicine, Pushpagiri Medical College, Thiruvalla, said 80 per cent of the patients admitted to the medical ward in the hospital were denied their insurance claim on flimsy grounds. Thankappan Chettiar, 60, from Avaneeswaram in Kollam district, was admitted to the hospital with upper oesophageal dysphagia on March 30. Dr. Sukumaran said the patient was suffering from anaemia too and it took more than 24 hours for making a definite diagnosis. Insurance company auditors rejected his claim saying that a definite diagnosis should have been made within 24 hours of his hospitalisation. The patient left the hospital without completing treatment after the company rejected his claim, he said.
. There were many similar instances of denial of eligible claims of patients suffering from liver diseases, low serum albumin, and thiamine deficiency, he said. Fr. Mathew Punakkulam, PMC Director (HR), alleged that the auditors appeared to be trying hard to reject the claims .
