Navigating Major Illness and Seniors' Insurance: My Lessons Learned

The last few months I’ve been supporting a parent through the diagnosis and treatment of a major illness, and it taught me some things I honestly wasn’t aware of before. So, I’m sharing the main things I learned along the way in case it helps anyone else (though I earnestly hope y'all and your families will never need this!).

Tablet Foils Are Not Senior-Friendly

Ever tried reading the shiny foil on medication tablets? Some of them are hard enough for even young eyes to decipher. But additionally, if you have a cut strip or you've worked your way partly through, you might not even know what you're taking because the printed name isn’t visible anymore! That too considering the daze that heavy medication and illness can put you in, this is an additional burden for an elderly sick person to handle. This seems almost a regulatory oversight because if the medication is for the heart or it’s chemo, that’s really dangerous… Me, I’ve taken to writing with black permanent marker on foils. (Tablet organisers don't help if you have the eat-this-in-case-of-that medication.)

Medical Insurance Process

These are documents it's handy to have soft copies of right at the start of the whole process:

• Policy membership card / ID card (or whatever equivalent name)
• Policy document + clauses document
• Aadhar card
• PAN card

As you go through the medical process, it's also good to have:

• Scan of a cancelled cheque leaf / passbook (in the optimistic event of your getting a reimbursement and needing to furnish bank account details)
• Spreadsheet documenting your expenses (esp ones submitted to insurance for reimbursement), the claim number against these expenses - in lengthy treatments you may have to raise multiple claims and it's confusing after a point to keep track of which number relates to which event, expense and date

The basic process is like this:

I'm just trying to be helpful, I'm not an insurance agent - so please read your policy to confirm that the above is valid in your case! You anyway need to check your policy terms and clauses for what's covered or not, and within how many days you need to make each submission. (There are deadlines.) Submissions have to be made in person, but a family member can go instead of the patient (insured) themselves. Similarly, the family member can also sign the insurance forms at the hospital for the patient for pre-approval submissions.

The Bad Faith Operations of Medical Insurance

1. It's astonishing that we really only get to see policy clauses after purchasing a plan. Even if we think we are insured for a generous amount, actual coverage that we're eligible for may be full of hidden sub-limits. Don’t be misled thinking that it's like car insurance and you’ll have a roughly proportionate coverage to the amount the policy is worth! Far, far from it, especially for seniors.
2. If you're handling medical insurance matters for someone else, the first thing you may need to do is change all contact details to your own. Otherwise every OTP, email, notification, etc. will go to the policy holder and you will be stuck especially when handling problems and follow-ups. For me, I moved into the same house, otherwise it would've been flat out impossible to help. Even though my parent shared over email that they were elderly and unwell and to contact me for anything, the insurance company has deliberately and always only ever contacted my ill, elderly parent.
3. Reimbursement is hell. As far as possible, try to get pre-approval.
4. Why does the insurance company require original copies of reports for major illnesses where they know the treatment takes months? Doctors need to see those reports continuously for treatment guidance, and yet the insurance company wants the reports as though they can’t accept scans. Plus – they anyway already make you sign a consent form that they can contact the hospital for further information they need. So really, why? Yet this is a thing. The best I could do was go the branch office and insist they scan the reports right then and hand them back to me. As you'll see further down this list, even that's not foolproof.
5. Never believe in the mythical callback. Write concerns and complaints on mail so you can also prove later that nobody has bothered to contact you or respond. (The company will anyway lie in mail responses that they tried to call you but that’s okay… Give a screenshot of your call records to the Ombudsman.)
6. Don’t take for granted that they will get your details right just because you filled a ton of paperwork and submitted proofs: they can get even the kind of hospital room you booked wrong and refuse to correct it for multiple rounds. And this matters because the room tariff can also influence the cost of medical equipment usage, nursing and every other charge during recovery!
7. Throw nothing away in a hurry: you know that chit on which the doctor scrawls a test recommendation? Keep even that safely because when you submit the test bill for reimbursement, you'll need to provide proof that the test was done at the doctor's direction and not because you wearied of having money.
8. The companies seem to operate on a principle of weaponised incompetence and harassment. Don’t give up. Don’t be worn down by their behaviour. You paid hard-earned money for your premium for years, they don’t get to rob you because they tired you out with the stonewalling and 'mistakes'.
9. Challenge any scanty coverage approvals with the GRO if your policy entitles you to better coverage. I’m yet to see any company actually read the complaint or do more than give a rote rejection, but you can’t approach the Ombudsman for help until you go through this process. Oh, and get the GRO email from the Ombudsman’s site – many insurance companies seem to deliberately show outdated phone numbers and email addresses for the GROs on their own sites.
10. Take up working out, meditating, gaping at trees, hugging your pets... anything that helps you relax because dealing with medical insurance companies is horribly stressful and will make you loathe humanity. This is as midly as I can express it.

Don’t Fear the Insurance Ombudsman

I found the Insurance Ombudsman appeal process to be really simple, reasonable and efficient! Yes, it may take a couple of months for them to get to your complaint (testimony to how insurance companies operate that the Ombudsman's office have such a volume of complaints to deal with). But, they do really help*. Don't be intimidated by the process or thing that this is like fighting a legal case in court. My experience was that I simply got a phone call, an official had a genuine conversation with me about what happened and why. One week after getting that call the matter was closed with the company being ordered to reimburse me (they had unfairly rejected the claim).

I'm saying this again, because people well-meaningly discouraged me so much about taking this route... Don’t hesitate to raise a complaint if you’ve been cheated or your medical insurance provider harasses you—just ensure you maintain an email trail. Always document your communications, whether they are follow-ups or complaints to the insurance company; they will help strengthen your case.

*The Ombudsman doesn't award damages or penalties. They will just help you get the money you're owed. If you want more, I think court is the only option. I've also reached out to the IRDA but they eventually directed me only to the Ombudsman.

Stationery Supplies are Your Friend

• The sheer volume of paperwork generated by way of medical records can be daunting. Invest in binders—one for bills, another for medical tests and prescriptions. You'll also find staplers and punching machines handy. Keep copies of everything submitted for insurance claims (preferably scans). I was grateful for my paranoid nature when the insurance company lost 2 pages of a test report and tore a scan image (originals, all). Despite pleading and explaining the seriousness of the illness, the company didn’t bother to reply to our request to look for or return the missing pages. So please take this seriously.
• Permanent markers help to keep tablet strips legible and sorted, as mentioned above.
• Not everyone can afford this, but if you have access to a scanner cum printer at home, it saves you a ton of footwork, time and coordination. See if you can borrow one from someone for the duration of the treatment at least even if you don’t own a printer/scanner yourself.

Honestly, handling medical insurance is a horrible and significant part of going through a major illness (as though there’s not enough going on). Don’t hesitate to ask your support systems for help. I had to do all this for myself before my parent fell ill, so the ‘test run’ helped me handle affairs for them. Still, I'm definitely no expert and I don't know everything in this arena. Please don't consider me an authority: I'm sharing what it would've helped me to know, that's all.

Do you have more wisdom or tips to share? What did you find helpful in your experience? I’d love to hear, learn and be better prepared, though I fervently hope you and I have no need to use such knowledge again…!

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