10/09/2025
“Dr. Shahb, full body check-up karwana hai, admit kar do.”
( in English : Doctor, I’d like a full body check-up, kindly get me admitted)
That one casual request distils the malaise of our healthcare system. Here, admission is not sought on grounds of clinical necessity but out of convenience, indulgence, or worse, the lure of an insurance claim. A hospital bed becomes less a place for the ailing than a stage for manufactured illness, and the absurdity of it is matched only by its frequency.
Why then are insurance companies now denying claims with such ruthless regularity? The stories are endless—patients left stranded, families scrambling, hospitals at a standoff, and insurers sitting smugly behind a wall of technicalities. The question is not whether claims are being denied—the evidence is overwhelming. The real question is why this is happening, and who bears responsibility.
The finger-pointing is predictable. Some blame hospitals, accusing them of concocting admissions out of thin air. Others fault patients for misusing their policies. And many, rightly, accuse insurance companies of being predators, driven not by care but by profit. The truth, as always, is messier. It is a sordid triangle of greed, negligence, and manipulation—with the hapless patient trapped at its centre.
Let us begin with the most blatant misuse. A “full body check-up” is not, by any stretch of imagination, an indication for hospital admission. Yet, such admissions happen daily under the garb of “preventive care.” Community-acquired pneumonia with a CURB-65 score of zero or one can be treated with a few days of oral antibiotics at home. Still, hospitals admit these patients, padding the bill with room charges, unnecessary investigations, and inflated consultation fees. Even rheumatoid arthritis pain, distressing though it may be, is not a clinical justification for admission. These are not emergencies; they are pretexts.
When such misuse becomes commonplace, the insurers inevitably react. They swing the pendulum in the opposite direction—towards blanket denial. No nuance, no discretion, no balance. Every case is viewed through the lens of suspicion. Thus, patients with legitimate conditions—fractures, myocardial infarctions, lupus flares—find themselves caught in a bureaucratic chokehold. Claims are delayed, rejected, or strangled in endless demands for paperwork. One man’s frivolous admission becomes another man’s financial ruin.
But let us not for a moment paint the insurers as helpless martyrs forced into denial by hospital misconduct. That would be a grotesque distortion. Insurance companies are not reluctant players in this charade; they are the chief architects of it. Their business model thrives on ambiguity. The fine print of their policies is deliberately opaque, written less as a promise of care and more as a minefield of exclusions. Clauses are invoked at whim, interpretations bent to suit convenience, and claims withheld with a straight face, even when the evidence is overwhelming.
The avarice of the insurance industry is legendary. They collect premiums with the enthusiasm of tax collectors, but when it comes to disbursing claims, their generosity evaporates. They arm themselves with jargon—“non-disclosure,” “pre-existing condition,” “not medically necessary”—phrases that sound clinical but are, in truth, weapons of denial. The patient, bewildered and desperate, becomes the victim of a system designed to exhaust him into surrender.
And what of the hospitals? Many have ceased to be temples of healing; they are now factories of commerce. Admissions are engineered, bills inflated, investigations multiplied—all to maximise the revenue stream. The patient becomes not a human being in distress but a “case” to be monetised. Doctors, often unwilling participants, are pressured into justifying admissions they know are unnecessary. The stethoscope becomes a prop; the real driver is the billing software.
Hovering above this unholy nexus are the politicians—the ever-present shadow. They feign outrage when insurance disputes make headlines, but in reality, they are complicit. Hospitals and insurers alike funnel profits into political coffers. Regulatory bodies are toothless not by accident but by design. Laws are drafted, amended, and selectively enforced to preserve the racket. It is a cabal, a cartel, a conspiracy masquerading as healthcare.
The fallout is devastating. Ordinary citizens, who scrimp and save to pay their premiums, are left stranded when illness strikes. Trust, the bedrock of any healthcare system, is shattered. Families who believed they had purchased security discover they have bought little more than false reassurance. The hospital blames the insurer, the insurer blames the hospital, and the politicians remain conspicuously silent. Meanwhile, the patient—the one person for whom this entire edifice is supposedly built—is reduced to collateral damage.
The irony is bitter. Insurance was conceived as a social safety net, a buffer against the financial ruin of illness. Instead, it has become a labyrinth of deceit, where both sides—the hospitals and the insurers—conspire to profit while the patient bleeds. Misuse begets denial, denial begets distrust, and distrust corrodes the very foundations of healthcare.
So, who is responsible? All of them. The hospitals that fabricate admissions, the insurers that weaponise fine print, the politicians who grease the machinery, and yes, even patients who collude in minor misuses, thinking it harmless. The system is broken not by one hand but by many, each complicit in its own way.
And until accountability is forced—until hospitals are made to justify admissions, insurers are compelled to honour claims transparently, and politicians are stripped of their profiteering—the cycle will continue. The innocent will keep paying the price.
Healthcare is not meant to be a marketplace. Illness is not a business opportunity. And patients are not commodities to be traded between greedy hospitals and predatory insurers. Unless we restore morality to medicine and integrity to insurance, the system will remain what it has become today: a grotesque theatre of greed, with the patient perpetually cast as the victim.
