A ₹38 lakh hospital bill—and the top-up claim that took months

₹38 lakh. He had done everything right: a base policy of ₹20 lakh and a ₹1 crore top-up with a ₹20 lakh deductible. On paper, he was well covered.What he had not anticipated was the process.

It took four months to receive the full claim. There were repeated requests for documents. At one point, the top-up insurer temporarily declined the claim because the base insurer had not yet settled.The claim was eventually paid.

But the journey was far harder than expected.In my previous column, I wrote about why top-up insurance is a cost-effective way to increase health cover. I also noted that the claims process with a base and top-up combination is rarely as seamless as a single policy. Here is why.A top-up policy pays only after expenses cross the deductible.The deductible is chosen when you buy the policy, typically between ₹3 lakh and ₹20 lakh.

If, like my friend, your deductible is ₹20 lakh, the top-up pays only after expenses exceed that amount.It does not matter who paid the first ₹20 lakh, your base insurer, your employer’s group cover, or you personally. What matters is proof that the expenses were incurred.If you paid the bills yourself, you must submit original bills, discharge summaries, diagnostic reports and payment receipts showing that the deductible threshold has been crossed.If the base insurer settled the claim cashless, you will still need the claim settlement letter showing exactly what the insurer paid the hospital. Without it, the top-up insurer cannot process the claim.