'How I claimed insurance after my son fell ill abroad'

A family holiday to Switzerland turned out to be my worst nightmare. On a Friday noon, my son had acute pain in his abdomen. A general practitioner in Switzerland advised my son to undergo an emergency appendicitis removal operation.

We were, obviously, apprehensive as we were in a strange country. However, after much thought we gave our consent for the operation late in the evening.

Amidst all this, I was wondering whether the insurance company (the travel policy was taken from a public sector insurance company) would actually pay up. The policy was part of a package taken through the tour operator who had made the travel arrangements for us. He in turn had used the services of an insurance broker to buy the package policy.

My experience in detail

Friday, May 23: My son got operated at around 10 pm. He was admitted and operated without us having to fill in an admission form or make any deposit. The hospital authorities did not even know whether we had insurance to cover the costs. Late at night, I sent an email to the International Third Party Administrators (TPA), The Indian TPA and the Indian insurance broker informing them of the impending claim.

Saturday, May 24: We decided to activate the claim process. The initial call to the Paris toll free number was not helpful, but I had received a response to my email from them indicating a file number for my claim and laying down the documents needed to process the claim.

I also spoke to claims executive, Prakash with the insurance broker in India. Prakash guided me on the procedures and also spoke to the TPA in Paris. The hospital in Paris were also helpful and provided the necessary facility for faxing the papers to the Paris TPA.

However, a confirmation from the TPA to the hospital was delayed because they wanted a medical report from the hospital before providing a coverage confirmation (which would have enabled me to avail of cashless facility from the hospital). The hospital informed me that this was not a usual request and it took a couple of hours before I could get the report and fax it to the Paris TPA. Meanwhile, since it was a Saturday I was forced to make a deposit (around Rs 1,25,000) to the hospital by using my credit card.

No final confirmation came from the Paris TPA. The Indian TPA had not responded at all.

Sunday, May 25: My son was discharged from the hospital. Hospital said the deposit was enough to cover the bill and they would refund the balance in due course by crediting the balance to my credit card account.

No final confirmations from the Paris TPA, though I kept receiving updates from Paris TPA. Paris TPA had also sent a confirmatory fax to the hospital (after the discharge).

Monday, May 26: The hospital confirmed that they had received the fax confirmation from the Paris TPA. The hospital said they would refund the deposit amount to my credit card after they receive the payment from the insurance company.

Prakash had been in touch with me through out.

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Tuesday, May 27: Return to India

First week of June: Submitted a claim to the Indian TPA for expenses such as general practitioner fee, the ambulance charges and the medicines purchased amounting to Rs 25,000.

Second week of June: Switzerland hospital refunded the deposit amount in my credit card account. I was shocked to discover there was a shortage of Rs 13,000 while credited to my credit card account.

Apparently, it was because the credit card company charges 3.50 per cent each way commission, making it 7 per cent in all. Also, the difference was due to the significant differential in the buying and selling rate of the foreign exchange.

Meanwhile, Prakash informed me that my other claim was approved on June 13 and I could expect a cheque in 15 days time.

July 2008: I received no cheque despite follow up. Finally, I sent an email notice to the Insurance Company saying I would take it up with the insurance ombudsman if I did not receive the payment.

August 4, 2008: I received the cheque through courier.

Experience taught me...

• Never pay by credit card overseas. Only the card issuer goes laughing all the way to the bank.
• The Indian insurance companies have specific requirements that make the process of pre-approval that much more difficult overseas as it is not in line with local practices.
• Moment you submit claims to the Indian TPA, brace yourself for delays.
• Use the 2 magic words 'Insurance Ombudsman' in your letters and emails. That's the one thing that makes the wheels move.
• The insurance broker is worth his weight in gold if they have people like Prakash working for them.
• While the delays were annoying and the amount retained by the credit card company was scandalous, I don't think I will ever venture outside Indian shores without a proper Travel Insurance policy.
• If you have to fall ill do so in country like Switzerland where even the general ward is better than the luxury suites of Indian Hospitals. The nursing staff actually helped us in booking a hotel for the night and summoned a taxi for us. A level of service that I cannot even imagine in India.

(The author is CEO of Apnainsurance.com , which is a comprehensive guide to insurance in India. It enables customers search and apply for all their insurance needs)

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