Home » Health insurance: according to a survey, 43% of subscribers had trouble filing claims after receiving treatment.

Health insurance: according to a survey, 43% of subscribers had trouble filing claims after receiving treatment.

by Samuel
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health insurance

Roughly 40% of patients encountered difficulties in submitting their health insurance claims. According to a poll, 43% of people with health insurance policies who made a claim within the previous three years had trouble receiving the money or paying hospital bills after receiving care.

insurance policy

In contrast to auto or other insurance policies, general insurance policy owners reported the greatest difficulty in processing health insurance claims, according to a Local Circles poll.

The policyholders mentioned that among the difficulties they encounter are claims rejections, approvals for only a portion of the total amount, and delays in paying hospital expenses.

According to the survey, policyholders face six main problems: incomplete disclosure of their policies’ exclusions and eligibility for claims; unclear contracts resulting from the use of technical jargon and complex words; claims denied because of pre-existing conditions; eligibility other than the pre-existing conditions; and crop insurance regulations related to the program.

Apart from this, the denial of health insurance claims, including policy termination by insurance companies, is one of the main complaints that customers have been making on a regular basis.

In additional explanation, customers stated that they encountered difficulties ranging from insurance companies only partially accepting claims due to a health condition being classified as pre-existing.

health insurance claim

They pointed out that filing a health insurance claim takes a long time, and many policyholders and their families practically spend the final day of their hospital stay rushing around attempting to have their claim handled.

The insurance claimants reported that because their health insurance claim was still being processed, in many cases, it took 10–12 hours after the patient was ready for discharge before they were actually released from the hospital.

They mentioned that in the event that they choose to remain in the hospital for an extra day, the policyholder, not the insurance company, would be responsible for paying for that extra night’s stay.

Regarding remedies, 93% of insurance holders expressed support for IRDAI to mandate insurance companies to publish information on authorized or denied claims, as well as canceled policies, on their websites monthly.

According to the poll, policyholders also demand cooperation between the IRDAI, the Health Ministry, and the Consumer Affairs Ministry to ensure swift and fair handling of health insurance claims, avoiding policyholder harassment.

Earlier this year, the Department of Consumer Affairs notified the Ministry of Finance to modify regulations, mandating insurance agents to keep audio-visual records of their sales pitch. This aims to ensure informed customers, addressing complaints of misrepresentation.

More accountability by all parties, including a suitable structure to carry out an audit of the solicitation process, consumer outcomes, and redressal methods, was allegedly under discussion at IRDAI.

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