"Medicep is a Scam: Struggling with Unfair Insurance Claims During My Father's Critical Illness"

Hello fellow redditors of r/Kerala, This is my first Reddit post, and it’s about a personal issue I’m facing. I am a second-year engineering student and the only son of my parents. My father is physically challenged and has been living with diabetes since his 30s. He’s now 66 years old. On September 29th, 2024, my father experienced sudden chest pain at around 7 AM. We rushed him to the nearest hospital with decent facilities under the Medicep scheme (KIMS Alshifa, Perinthalmanna). Since it was an emergency, an angiogram was conducted, revealing two severe blocks that needed immediate angioplasty. Given the urgency and the fact that we had insurance, we agreed to proceed with the angioplasty. The procedure was successful, but due to his weakened kidneys, there was a sudden rise in creatinine levels, triggering temporary kidney dysfunction. He spent two days in the ICU, during which dialysis was performed twice to stabilize his kidneys. Thankfully, that was successful. However, other complications delayed his transfer from the ICU. After seven days in the ICU, he was shifted to a regular room, where he underwent another seven days of treatment. Now, here’s the shocking part: although the Medicep insurance coverage is ₹6 lakhs, our hospital bill came to ₹3 lakhs, and yet Medicep only covered ₹63,300 initially. My father, who is our sole earner with a monthly pension of ₹22,000, had no means to cover the rest. We had to borrow money from relatives and take a gold loan to pay the remaining amount. After discharge, we inquired why we received such a low reimbursement. The Medicep office told us to file a grievance report, which we did, but nothing came of it. After my father sought help from some of his colleagues, they escalated the issue, and we eventually received an additional ₹22,000, making it a total of ₹83,000—still far below half of the bill. Fast forward to December 7th, 2024: my father was hospitalized again due to severe fever and shivering. It turned out to be a urinary tract infection that affected his kidneys. After eight days of treatment, while the urinary infection was resolved, a lung infection occurred due to food particles entering his lungs. This caused breathing difficulties and led to fluid buildup in his lungs, requiring ICU admission on December 23rd. After 15 days of treatment, his condition worsened, and he became unconscious due to high CO2 levels in his blood. It reached a point where ventilation was considered, but thankfully, pressurized BiPAP treatment worked. However, his condition remains serious. He has undergone three dialysis sessions in three days, and his urine output is still insufficient, which is alarming. Doctors are saying that more dialysis might be required to stabilize him. As of now, our hospital bill has reached ₹2,19,000 and is still rising. When we asked how much Medicep would cover, they estimated around ₹23,000, which is absurd, especially since the remaining insured amount is ₹5.17 lakhs. I don’t know what to do anymore. My family is financially strained, with no other income source, and we had pinned all our hopes on this insurance scheme, which has turned out to be a major disappointment. Please help! What steps can I take to claim the full amount we are entitled to under Medicep? I know this is long if anyone has read this far thankyou for your time. 🙂