It happened when I was born. Technically, weeks earlier.
My heart was built with a minor defect. Sometimes, there was a longer-than-normal pause between its beats. Perhaps I was meant to take pauses, live life slowly.
I was slow in my student years, thanks to my “healthy” build (in today’s non-discriminatory parlance). I was fat, timid, quiet, slow. It took me years to learn how to ride a bicycle and much longer than my schoolmates to finish school. It took me longer than my colleagues to get into a journalism school and get promotions. For the most part, I didn’t wait to get promoted; I jumped job to job every couple of years, hoping to reach higher with every jump.
Living with an Unreliable Clock
My heart was jumping a beat or two at that time too. But I didn’t know that until I was in my early 30s. I had married by then, had a family, and respectable jobs for a few years to need life insurance. An LIC (Life Insurance Co. of India) agent wandered into my life, as they usually do in India, and convinced me to buy a policy. The LIC has launched well over 200 distinct insurance plans (with different riders) since 1956 and currently has about 261.5 million individual policies in force. I have bought a number of those for myself and my family over the years.
My LIC agent also became my investment advisor, as they usually do in India, along with uncles, cousins, friends and colleagues, who are not all equipped for the role. In that respect, we became friends over time. Thanks to his timely guidance and help in ways more than I can count, my wife and I managed to kickstart our financial planning and save enough to buy our first home.
A medical examination for the first insurance policy revealed the defect in my heart. But it was too insignificant to worry about. I didn’t have any symptoms that could be linked to the jumpy heart, and no medical intervention was needed. It remained little more than a footnote in my periodic medical test reports.
Even the stress of personal and professional pressures had little impact on my heart. I worked in highly stressful environments, first in time-sensitive newsrooms and then in politically sensitive jobs in the UN. I did suffer from stress and had to be treated for depression several times during our stint in Europe. But I was known for having low blood pressure, both medically and figuratively. The heart was apparently having a good run still. After an intensive regimen of cardiological tests done in view of stress-induced symptoms, a Danish cardiologist exclaimed: “Yours is one of the best hearts I have seen!” I hoped he was not just being figurative.
Ironically, when I retired and we returned to India to live a relaxed retiree’s life, my blood pressure became jumpy. My racing heart and episodes of dizziness led to several rounds of tests. After ECGs and echocardiograms, I had to go for ambulatory rhythm monitoring several times, starting with 24-hour monitoring to 3-day and 5-day monitoring to catch the elusive beat.
Changing the Heart’s Rhythm
I was diagnosed with sick sinus syndrome (SSS), a condition in which the heart’s natural pacemaker doesn’t work properly.
Think of your heart as having its own built-in clock. This clock, called the sinoatrial (SA) node, sits in the upper right chamber of the heart and sends electrical signals that tell the heart when to beat. In sick sinus syndrome, this clock becomes unreliable. Because of this, my heart paused for a few extra seconds between the beats. This can happen with age, but my medical history showed that it was a manufacturing defect. Its symptoms emerged only now, causing dizziness and palpitations. But the symptoms remained mild enough and the pause was brief enough for the cardiologist to advise regular monitoring with a Holter device, without going for any intervention. I took medicine to lower my blood pressure in winter when it spiked in a regular pattern.
After three years of monitoring, the pause in my heartbeats was found to be longer than the acceptable duration. It was time to replace the heart’s unreliable clock, my cardiologist advised. Let’s put in an artificial pacemaker to restore the rhythm of your retirement, he said.
I was not keen on interfering with the original machinery of my body. But left as it is, the longer pause could increase the risk of falls from fainting and injury, the cardiologist warned. Imagine breaking a limb or two, or a head-brain injury, in old age at that!
That fear undid my determination to let nature take its course. I eventually agreed. The implant itself was remarkably smooth, although the overall experience turned into a nightmare for reasons I have previously written about.
When Cashless Care Turned Costly
Modern pacemakers do not come cheap. Their prices will send your heart racing, and you need health insurance to cover the cost of such expensive procedures.
On returning to India, we purchased health insurance policies from a leading private insurance company. I had assumed that as health insurance became more common in India, claims would become easier to settle. The opposite seemed true.
Health insurance now accounts for over 40% of the country’s non-life insurance business, and the sector continues to grow rapidly. Yet growth in premiums has not always translated into a smoother experience for policyholders.
The insurance company approved cashless payment for my hospitalisation for the pacemaker implant. Which meant I could go through the procedure and return home without having to worry about the bills; the insurance company would pay at discharge.
Only, that was not to be. On the third day of my hospitalisation, the cardiologist signed off on my discharge papers in the morning. But the final payment authorisation didn’t arrive even after 12 hours. I gathered from the nursing staff that the insurance company had queries about my glaucoma treatment. Eh?
I am using eye drops for glaucoma, another inherited condition that I have lived with for about 25 years. I carry the eye drops with me whenever I am away from home. So I took them with me to the hospital and asked the nurses to instil them in my eyes as per the prescription.
This fact, noted in my hospital records, triggered a query in the insurance company’s claim settlement system. Did I have sick sinus syndrome for 25 years and didn’t inform the insurer? The hospital’s TPA team (the third-party administrator in the medical insurance system) and my cardiac surgeon patiently explained that I had been treated for sick sinus syndrome for only two-and-a-half years; it was glaucoma that dated back 25 years.
My family was getting desperate to get me home after a 12-hour wait for the insurance company’s approval. So we decided to pay the bills from our savings and get reimbursed later. “When it’s time to pay, they take their own sweet time,” the cardiologist had commented that evening. I got home close to midnight after we had emptied our coffers.
Five Months Under Process
5 months. 15 rounds of queries. 100 uploads of documents. These are the milestones of my reimbursement claim filed with the insurance company.
First, a young gentleman visited me at home to verify the documents. All is fine, he said, and the claim should be approved in a couple of weeks. Then came the automated emails every couple of weeks, saying “a few additional documents are required”, and assuring the claim would be processed within 15 days. The process of submitting the documents was immensely frustrating: you cannot upload more than a certain number of files to their self-help portal, or those larger than the limits they set. You cannot email the documents to them because of similar attachment restrictions. The portal will freeze in the middle of an upload. Call their helpline, which can give you no more detail other than that your claim is “under process”, which their app also shows, without further clarification. If you complain about difficulties with the email, app or website, the helpline staff adopt a condescending tone, assuming the customer is illiterate about such things, especially if he is a senior citizen.
I went to the office of the insurance provider in my city: the staff were friendly, but could not give any insight into the delay. It was “under process”, they said, and they could only receive copies of all the documents I had already labouriously submitted for “further processing”. I met a man there who was also chasing his reimbursement claim several weeks later.
The insurer, widely regarded as one of India’s most reliable, could do well with more transparency in their claims resolution process. Why was my claim not being approved for 5 months? Which particular bill, prescription or test report was missing or deficient in information? A few of the emails asked for specific documents, like “all the past medical papers related to glaucoma treatment”, but most were generic, with the same template list of documents to be submitted.
Call the helpline, email the support team, send messages via WhatsApp: it all seems like hitting a wall. What bounces back are automated emails and scripted answers via AI-driven chatbots.
Is there any human out there to consider that they are dealing with human patients, I wondered often, as my blood pressure rose at the unfairness of their process and attitude.
Apparently, there are. Their sales department started calling me repeatedly as my insurance policy was nearing its renewal date. Why should I renew my policy, I asked them angrily, when you don’t pay for my hospitalisation? “Our claim settlement rate is the industry’s highest,” the sales staff informed me. “Your claim is under process. Did you provide the documents needed to process your claim?”
Escalation and Resolution
5 months into this process, I made a complaint on the company’s website. “I want an answer, whether acceptance or rejection, as soon as possible so that I can take the next steps accordingly,” I wrote.
Within a few minutes, the status of my complaint changed to “resolved”. I called customer care to ask what it meant as I had not received an answer. They did not have one, nor an explanation of what it meant.
As my grievance remained unresolved, I escalated the matter. I wrote to the company’s Grievance Officer. It was not only frustrating but also humiliating for me that my claim was being treated like a fraud case even after the cardiologist, the hospital and my opthalomolgist had given written clarifications about my treatments.
They would “provide resolution within 2 weeks from the date we have received your complaint,” came the prompt reply.
All these months, every fortnight another automated email arrived asking for “additional documents.” After the sixth or seventh such email, I stopped asking when my claim would be settled and started asking how often this happens to others.
The Numbers Behind My Story
Although my insurance provider says it has the highest claim settlement ratio in the market, there are nuances in the story. Settlement doesn’t always mean full payment of the claimed amount. The industry data for 2023–2024 shows that about 82% of claims were settled by number, but only about 71% of the total claimed amount was paid. That means nearly 30% of the medical costs are not covered by insurance providers for one reason or another.
During those five months, I began wondering whether I was unusually unlucky or whether thousands of other policyholders were going through the same ordeal. I discovered that I was far from alone. During 2024-2025, the Insurance Ombudsman received over 37,000 health insurance-related complaints. Only 13% of the complaints disposed of by the Ombudsman ended in favour of insurers, whereas 41.5% resulted in favour of policyholders.
Recent government data also shows that “claim not disposed of” has become the single largest category of insurance grievance received by regulators, ahead of outright claim rejection.
As I read more, I found that courts had repeatedly questioned insurers who rejected claims on flimsy grounds. In one recent case, a consumer commission ruled that an insurer could not allege a pre-existing illness without credible evidence. Another Supreme Court judgement emphasised that not every omission in a proposal form justifies rejecting a claim. Those decisions reassured me that persistence was not unreasonable: it was often necessary.
As it is, premiums for health insurance are much higher for older citizens. Insurers make it worse for policyholders by denying payment of legitimate treatment costs and delaying the settlement of claims.
A report by Purnima Sah in *The Indian Express* describes the experience of Dr Prasun Chatterjee, group clinical lead of Geriatric Medicine and Longevity Science, Apollo Hospitals, who “has seen that even when patients have health insurance, many families struggle with reimbursement or do not receive financial support from insurers at the time they need it most.” I am reminded of the cardiologist’s comment. And I am trying not to worry about the interest we lost on our savings in these months.
Don’t Lose Heart
While I was researching my options, the Grievance Officer’s 2-week deadline passed. I sent him a final notice of escalation: If I did not receive a final written decision within seven days, I would have no option but to pursue the matter before the Insurance Regulatory and Development Authority of India and the Insurance Ombudsman, I wrote.
Call it coincidence or the power of perseverance, I received the approval for my reimbursement claim in two days.
So if you are caught in a similar situation, don’t miss a beat and don’t lose heart. Many others have walked this path. Justice may be delayed, but persistence can make the difference.
I have now submitted a new reimbursement claim after being hospitalized a second time for treatment of typhoid. Watch this space.
(The writer is a former journalist and communications professional.)
Wow, I am wishing all the strength of being healthy and for your stout heart to become even more stout. This health insurance is a problem all over the world. It seems like profit amounts to all these companies ever worry about. Even people who are wealthy don't like to be way overly shortchanged on the benefits. People will have to spend even more money for supplements to cover the 30% these rascals refuse to pay. With AI there is no more human interest or interest in any humans, so if you, dear reader, are still even remotely interested in any humans, you need to read Kanti. Kanti Sir, you are still a true journalist when many journalists have become publicists for political fictions all across the political and social spectrum!
Dear Kanti, so sorry to hear that you had to go through all this. Wishing you more strength and good health! Still, very entertaing reading and you write so well. But my goodness, what a complex insurance system!