Fri Feb 21 14:00:40 UTC 2025: **Tamil Nadu’s Health Insurance Scheme Faces Criticism Over High Claim Denial Rates**

Chennai, February 21, 2025 – The Chief Minister’s Comprehensive Health Insurance Scheme (CMCHIS) in Tamil Nadu is facing criticism over high claim denial rates, particularly impacting government hospitals. Data reveals that nearly 29,000 claims totaling ₹36 crore were rejected between April 2024 and January 2025. Chennai reported the highest number of denials, followed by Madurai, Tirunelveli, Thanjavur, and Coimbatore. Hospitals such as Madurai Medical College and Madras Medical College were among the hardest hit.

Doctors interviewed by The Hindu cite “flimsy” reasons for denials, including minor discrepancies in paperwork like spelling errors in patient names, late submission of X-rays or CT scans, and variations between CMCHIS and Aadhaar card information. The need for immediate pre-authorisation, even for emergency cases, is also highlighted as a major hurdle. Doctors argue that such stringent requirements impede timely treatment and add to the burden on already strained healthcare systems.

The issue extends to the amount approved, with doctors reporting instances where only half or less of the claimed amount is approved. The lack of clarity regarding the outcome of a 2023 government committee formed to streamline the scheme further fuels concerns.

While Health Minister Ma. Subramanian has promised to investigate the matter, the high denial rates raise serious questions about the effectiveness and accessibility of Tamil Nadu’s ambitious health insurance program. Doctors are calling for a simplification of procedures and an audit of rejected claims to ensure the scheme truly benefits those it intends to serve.

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