Delays arise from both insurer-related issues and hospital-related issues, such as hospitals not adhering to all insurance provider requirements
FinTech BizNews Service
Mumbai, May 30, 2024: IRDAI announced the Master Circular which entails to adopt customer centric policies. Dr. S Prakash, MD/CEO Designate, Galaxy Health and Allied Insurance, has shared a perspective on this development:
"Like our regulator, IRDAI, insurance players like us too hold the vision of "Insurance for all by 2047." The Master Circulars introduced by IRDAI encourage insurers to adopt customer-centric policies. A focus on customer satisfaction can positively impact insurance penetration in India. This will lead to a UPI-like movement (deeper penetration and high adoption) within the health insurance ecosystem.
Technological advancements and faster claims: Given the technological capabilities of the insurance ecosystem, IRDAI's directive for cashless approval within one hour and claim settlement at discharge within three hours seems realistic and achievable with a deadline of July 31st. Typically, insurers settle claims within two hours, except during nights and holidays. Delays arise from both insurer-related issues and hospital-related issues, such as hospitals not adhering to all insurance provider requirements. The National Health Claim Exchange (NHCX) aims to address this hurdle by the regulator.
Reducing claim rejections: Fraudulent activities (e.g., hospital overcharges or unnecessary investigations), customer non-disclosure (suppressing pre-existing conditions), and incomplete hospital documentation are the most common reasons for health insurance claim rejections. The Master Circular aims to reduce rejections and deductions by tackling misrepresentations and non-disclosures.
Need for expertise: The complexity of insurance products combined with a lack of expertise among insurers and third-party administrators (TPAs) is a challenge. The insurance industry needs trained personnel who understand both medical science and insurance products and procedures."
