Your claim was approved, so why did you still pay 40% of the bill?
Approval and full payment are two different things. Here is where the deductions come from.
An approved claim can still leave a large balance at the discharge counter. The deductions are rarely arbitrary - they come from named clauses.
The five common deductions
- Room rent proportionate deduction. Covered in detail in our guide on room rent limits.
- Non-medical consumables. Gloves, syringes, administration charges, sanitisers, PPE - often 5 to 15% of a surgical bill and excluded unless a consumables cover is added.
- Co-payment. A fixed share of every claim, common on senior citizen plans and on some zone-based pricing.
- Sub-limits by procedure. Cataract, hernia, knee replacement and maternity often carry their own caps regardless of the sum insured.
- Pre and post hospitalisation windows. Usually 30 and 60 days. Bills outside the window are not payable even when clearly related.
What to do at admission
- Ask the insurance desk for the pre-authorisation letter and read the deductions listed on it.
- Ask the hospital for an itemised estimate, not a package figure.
- Tell your broker before the procedure, not after discharge.
What to fix at renewal
Consumables cover, removal of the room cap, and a super top-up above the base policy usually cost less than most people expect, and they address the three largest sources of out-of-pocket spend.
The exact deductions applied depend on the insurer wording. We review the bill against the policy and challenge deductions we believe are wrong.