₹8.27 lakh bill, ₹10,000 refund: Medisep 2.0 under fire as cashless promise falters

Thiruvananthapuram: Complaints are mounting against the second phase of the Medisep health insurance scheme implemented by the state government for employees, pensioners and their dependents.

Key grievances include hospitals overcharging patients, demanding advance payments before treatment, and insurance companies rejecting claims without valid reasons.

In a recent case, a Kasaragod native spent ₹8.27 lakh on treating his son, who suffered serious injuries in a road accident, but received only ₹10,000 as reimbursement. Complainants also alleged that calls to the Medisep toll-free helpline for grievance redressal go unanswered.

Medisep 2.0 was rolled out on February 1, following widespread complaints about the first phase, along with a hike in the monthly premium. Around 10 lakh beneficiaries are now paying ₹687 per month. The scheme offers an annual treatment cover of ₹5 lakh.

The government had said the premium hike would enable higher treatment packages and bring more hospitals under the scheme.

Though empanelled hospitals have agreed to fixed package rates, patients are often billed far beyond these rates after treatment. While the approved portion is claimed through Medisep, the remaining amount is collected directly from patients. In many cases, insurance approvals cover less than 10 per cent of the total bill.

With uncertainty over reimbursements, hospitals have increasingly begun insisting on advance payments. Even after treatment, patients are required to clear pending dues before discharge, with refunds processed only after claims are settled—effectively defeating the scheme’s cashless promise.

Calls to the toll-free grievance number reportedly provide only recorded messages, with no option to speak to a representative. As a result, many beneficiaries are approaching district consumer dispute redressal forums, where complaints related to Medisep are on the rise.