Health Insurance: Difficulties in reimbursement claims
If you have taken health insurance and are facing problems from claim to payment after treatment, then this report is for you. Local Circle has surveyed about 40 thousand people across the country. The survey revealed that after making a claim, one has to face a lot of problems ranging from rejection to approval of partial payment. Even if the patient gets rid of the disease, the health insurance company increases his problems.
73 year old Rama Bansal, living in Sector 151, Noida, had to go through a similar situation. He had retina surgery at AIIMS last year. Doctors discharged him after three days due to other serious illnesses. At first the health insurance company refused reimbursement. When payment was made by taking a note from the doctor, Rs 9,000 less was received in that too.
It is noteworthy that there have been many cases of health insurance service provider companies refusing to pay the insurance amount due to the customers. There were also allegations of insurance companies giving various excuses to the customers to avoid paying the money and due to this the insurance regulatory body IRDA had also issued a warning to the health insurance companies.
The company did not pay the full cost of the surgery
Rama Bansal’s daughter Sampi Bansal told that the bill for her mother’s retina surgery at AIIMS was Rs 27 thousand. The health insurance company initially rejected the claim. Partial reimbursement was paid after showing written acceptance. Paid only Rs 11-12 thousand. The health insurance company did not pay Rs 9 thousand saying that there is no need to stay more than 24 hours for the surgery. This is not just the Bansal family. Many families are facing this situation.
Claims processing is the biggest difficulty
Sachin Tapadia said that responses were received from 302 districts in this survey. 40 thousand people took part in the survey. He said that in the last four years a lot of problems were faced in claim clearance. Processing of claims is the most difficult. Claims are being rejected. It takes a very long time to get it approved. This has increased the problems of not only the patient but also the hospital.
15 to 17 percent people have not received reimbursement payment
Not only this, the Bansal family also did not get the answer that there was no need for further hospitalization. Many families have already received this answer. Sachin Tapadia, founder of Local Circle, says that in the online survey which lasted for three and a half months, 43 percent people have given information about the problems faced in health insurance claims during the last three months. A survey was conducted on 39 thousand people from 302 districts of more than 20 states of the country. Five percent said that their claim was rejected by the company. 15 to 17 percent said that the company paid by reducing the claim amount. 20 to 25 percent said that it took a lot of time to settle them. Had to face a lot of trouble during that time.
