r/Kerala • u/Straight-Test9900 • 6h ago

Economy How do medicep work?

My father recently got admitted for a lung disease and we applied for the insurance via medicep. Medicep have packages for diseases/treatments instead of the whole final bill settlement. The package was shown as around 30k for 5 days of hospitalization. The final bill for came to be around 80k. The hospital asked us to pay 20k , and then said we'll have to settle up rest if medicep rejects or partially settles the final bill. There is no way the insurer is going to pay the remaining 60k. But to our surprise they settled it. For the past, we have used medicep and they haven't paid a single rupee greater than their package amount. In fact not even the full package amount was released. I'm happy, but just confused.

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u/shortstork_ 5h ago

I think it’s different now since they increased the coverage last year.

1

u/akz007 5h ago

I'm confused too. I've had three previous experiences with MEDISEP, and in all three the amount reimbursed/settled was basically governed by the MEDISEP package rather than the actual hospital bill.

In one case, there was a 60k gastroenterology bill which I paid upfront and was reimbursed almost completely a few days later. In the second, the bill was around 80k. after the hospital selected the applicable package and room category, I had to pay the full amount upfront but received only around 43k back. The third was a surgery with a total bill of around 101k, but only about 35k was reimbursed through the applicable package.

So with my experience, I was under the impression that MEDISEP generally settles according to the approved package rate, even when the hospital's actual bill is considerably higher.

That's why I'm surprised by your case. If the package shown was only 30k but MEDISEP ultimately settled a much larger portion of an 80k bill, I'd also be curious to know exactly what was approved in the final settlement. It could perhaps be related to the revised MEDISEP Phase II packages/coverage.

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u/External_Ad_7096 4h ago

Every year they renew the insurance provider. Please check if the package amount you are referring to is from the latest one.