Difficulties in Getting Health Insurance Claims: A Survey Report

Business View
5 Min Read

It is an undeniable fact that health insurance is important to provide long-term financial security but most consumers are finding difficulty in getting claims over their health insurance. The recent survey reports are asserting this claim and disclosing that despite completing all the formalities many consumers are not getting the benefits of their health insurance. The survey report says that 43% of health insurance policyholders had faced problems while processing their health insurance claims in the past few years on an aggregate basis. This survey has been conducted by LocalCircles who collected the data of the past three years and revealed many shocking facts. 

According to the LocalCircles survey report, “Challenges faced ranged from insurance companies rejecting claims by classifying a health condition as a pre-existing condition to only approving a partial amount.” The majority of those who shared their thoughts on the subject stated that the process of claiming health insurance is quite tough and time-consuming.  According to them, during the process of getting claims over health insurance, several policyholders and their family members usually spent the last day of their hospital admission running around attempting to have their claim processed timely. 

The survey states that “In several cases cited by policyholders on LocalCircles, it took more than 10-12 hours after the patient was ready for discharge for them to actually get discharged because the health insurance claim was still getting processed.” The entire process of getting approval over the claim is so exhausting that the patient usually avoids getting involved in the process of any disapproval of expenses made by the insurance company. But, by the time the claim is approved, the consumers are so exhausted that they have no more strength left to fight for any expenses that the insurance firm rejects. 

Even if the patients decide to stay back at the hospital for one more day to get the overall approval, the cost of that additional day or night has to be paid by them. Several patients have shared their opinions on this matter and said this is an experience where the insurance company has already given pre-approval to the TPA desk of the hospital prior to the admission of the patient. It is not like the authorities have not taken any action on this as the Insurance Regulatory and Development Authority of India (Irdai) has made interventions several times. But despite their intervention, the policyholders continue to wrestle with insurance companies to get their health insurance claims. 

The survey came after learning about the situation of the consumers who are facing numerous difficulties while getting the claims of their insurance. As per the report, the consumers or policyholders have been regularly writing about the issues and the rejection they have faced while getting the health insurance claims including the unjustified cancellation of the policies made by insurance companies. 

To understand the process of health insurance, how people purchase general insurance, what kind of policies they purchase and where they face the most difficulties, LocalCircles decided to hold a national survey in which they registered the responses of more than 39,000 people located in 302 districts of India. After receiving the responses from the citizens, they concluded that at least 43% of consumers are struggling with these issues. 

The report said, “67 per cent of respondents were men while 33 per cent of respondents were women. 46 per cent of respondents were from tier 1, 32 per cent from tier 2 and 22 per cent respondents were from tier 3, 4 and rural districts.” 

Moreover, the query got more than 11,318 responses with 93% pointing out that they are in favor of Irdai making it compulsory for all the insurance companies to reveal the details of claims received and rejected including the data about policies approved and canceled on their websites. The insurance companies need to share all the details every month on their website. 

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