43% of health insurance policyholders face claim processing hurdles: Survey

Health insurance claim challenges: As much as 43 per cent of health insurance policyholders encountered difficulties in processing ir claims after receiving treatment, according to a recent survey conducted by LocalCircles. study highlighted that individuals with general insurance policies faced most challenges compared to those with motor or or insurance coverage.

Amongst respondents who h filed a claim in past three years, nearly four out of ten patients struggled to receive ir entitled funds or settle outstanding payments at hospitals following treatment.

Policyholder issues identified

survey shed light on six primary issues faced by policyholders, including insufficient disclosure regarding claim exclusions and eligibility criteria, contractual ambiguity due to complex terminology, claim rejections based on pre-existing conditions, eligibility criteria beyond pre-existing illnesses, and complications arising from crop insurance regulations.

Furrmore, policyholders expressed frustration over frequent claim rejections and policy cancellations by insurance companies. y recounted instances where insurers rejected claims by categorising certain health conditions as pre-existing, or only offering partial reimbursements.

Describing cumbersome process of claiming health insurance, many policyholders recounted spending significant time and effort, often up until last day of hospital mission, to facilitate ir claims. In some cases, patients experienced delays of up to 10-12 hours post-discharge due to ongoing claim processing, leing to ditional financial burdens if y opted to extend ir hospital stay.

Policyholder transparency vocated

Proposing solutions, 93 per cent of respondents vocated for greater transparency from insurance companies, urging regulatory bodies such as Insurance Regulatory and Development Authority of India (IRDAI), Ministry of Health, and Ministry of Consumer Affairs to collaborate in ensuring fair and efficient processing of health insurance claims, without subjecting policyholders to undue harassment.

In response to mounting complaints regarding insurance policy mis-selling, Department of Consumer Affairs proposed revisions to regulations, including mandatory audio-visual recordings of sales pitches by insurance agents. This measure aims to ensure prospective buyers are fully informed about policy features, rar than solely focusing on positive aspects.

Notably, IRDAI is considering enhanced accountability measures for all stakeholders, including frameworks for auditing solicitation processes, assessing customer outcomes, and strengning redressal mechanisms.