Health Insurance Claim: People typically seek health insurance to reduce their medical expenses. However, this health insurance is now becoming a problem for many policyholders. This is because hospitals are delaying discharges. Learn about the full story.
Health Insurance Claim: Even after obtaining health insurance, receiving payment is a hassle. Insurance companies harass patients before paying their health insurance claims. Sometimes, patients have to wait six to 48 hours after discharge. According to a report in the Economic Times, many insurance companies immediately approved treatment for their policyholders (patients), but took a long time to process payments. This caused many difficulties for policyholders.
Some insurance companies approved treatment for patients, but when making payments, they stated that the illness existed before the policy was purchased, claiming the policyholders had concealed the illness. However, when policyholders provided evidence and doctors’ reports, the insurance companies had to adopt a lenient approach. However, patients still had to pay an additional room rent.
Health Insurance Claim: Even after obtaining health insurance, receiving payment is a hassle. Insurance companies harass patients before paying their health insurance claims. Sometimes, patients have to wait six to 48 hours after discharge. According to a report in the Economic Times, many insurance companies immediately approved treatment for their policyholders (patients), but took a long time to process payments. This caused many difficulties for policyholders.
Some insurance companies approved treatment for patients, but when making payments, they stated that the illness existed before the policy was purchased, claiming the policyholders had concealed the illness. However, when policyholders provided evidence and doctors’ reports, the insurance companies had to adopt a lenient approach. However, patients still had to pay an additional room rent.
Why is discharge delayed?
IRDA’s deadline for approving the final claim after receiving the discharge summary and bill is set. Most discharge delays are due to administrative and bureaucratic issues. Some delays are also due to medical reasons. It is also being reported that a certain amount is approved by the insurance company before treatment, but this amount is higher in the final bill. Coordination between the insurance company, policyholders, and the hospital takes a long time. Coordination between hospitals and insurance companies is also considered very poor. Consequently, patients have to spend additional days in the hospital.
Uninsured patients are discharged from the hospital more quickly.
There have been many discussions about how to expedite discharges. Experts say that hospitals should grant discharges before the patient is due. Administrative delays are significant, and this should be reduced. More companies should join the NHCX platform, created by the National Health Authority. This will reduce the long wait for claim settlements. Insurance companies also say that one reason for this is that many hospitals still operate on “outdated IT systems” that are not customer-friendly. Consequently, it takes approximately 3.5 hours for uninsured patients to be discharged, while it takes more than five hours for insured patients.
The insurance company must process the claim within three hours.
According to Insurance Regulatory and Development Authority of India (IRDAI) regulations, insurance companies must approve the bill within three hours of receiving the final bill and discharge summary. Any extra room rent incurred due to delayed discharge must be paid by the insurance company from the shareholder’s fund. Before these regulations, this expense was part of the claim and reduced the customer’s sum insured.
NHCX Platform Created for Claims
At least 33 major health insurance companies have been integrated into the National Health Claims Exchange (NHCX), a platform created by the government for the exchange of information related to insurance claims. Previously, this process was conducted through several different platforms, which was time-consuming. Government sources say that using NHCX will not only speed up the insurance claims process but also make the entire process transparent. This will provide the Insurance Regulatory and Development Authority of India (IRDAI), the country’s top insurance regulator, with real-time information on the status of claims settlements.
