survey-finds-over-40-of-health-insurance-policyholders-encounter-claim-issues

A recent survey conducted by LocalCircles has shed light on the challenges encountered by health insurance policyholders, with over 40% facing difficulties in securing payments for medical treatments.

 

The insurance policyholders who submitted claims in the past three years, a significant 43% reported facing issues with receiving their money or settling hospital bills after treatment, according to the survey.

 

The study pointed out that policyholders of general health insurance faced the most trouble compared to those with motor or other insurance policies. 

 

Common problems reported included claim rejections, partial approvals of claimed amounts, and delays in settling hospital bills.

 

Identifying six major issues impacting policyholders, the survey highlighted concerns such as a lack of complete information about claim exclusions and eligibility criteria, confusion arising from complex contract language and technical terms, and claims being rejected due to pre-existing conditions.

 

The challenges related to eligibility criteria not directly linked to pre-existing conditions, issues specific to crop insurance regulations, and regular reports of health insurance claims being rejected or policies being canceled by insurance companies were also noted.

 

Policyholders described the process of claiming health insurance as excessively time-consuming, often requiring significant effort and time from both policyholders and their family members.

 

Many individuals reported having to manage claim processes until the last day of hospital admission.

 

In certain cases, discharge from the hospital was delayed for 10–12 hours post-patient readiness due to ongoing claim processing.

 

In response to these challenges, 93% of insurance holders expressed support for the Insurance Regulatory and Development Authority of India (IRDAI) to mandate insurance companies to publish monthly data on claims received, rejected, approved policies, and policy cancellations on their websites.

 

Policyholders urged IRDAI, the Health Ministry, and the Consumer Affairs Ministry to collaborate to ensure fair and prompt processing of health insurance claims without causing harassment to policyholders.

 

IRDAI is reportedly considering greater accountability measures, including enhanced audit frameworks for the sales process, customer outcomes, and complaint redressal mechanisms, to address these concerns.