May 07, 2021

'Insurance firms have the responsibility to ask the right questions on claims'

Amid the rise in the number of covid cases, there has been an unprecedented increase in the number of health insurance claims. While insurers have accelerated the claim settlement process on covid-19, some cases are also getting rejected.
In an interview with Mint, Dr S. Prakash, managing director, Star Health and Allied Insurance, said there is a increase in the number of claims as people are rushing to the hospital not knowing whether they require admission or not. At the same time, the health insurance sector, which is highly regulated, is behaving differently towards the process of claim settlement owing to differential charges and the lack of common simple protocol for hospitals.
Are insurers denying claims?
No, it is not the case; it should be looked at differently. It is not that insurance companies are not paying the claim; insurance companies have to pay the claim. There is not only an unprecedented increase in the number of claims but also a phenomenal increase in the average amount paid per claim.
Insurance is a highly regulated sector. Unlike healthcare services, which is not regulated, insurance companies cannot deny payment of claims. But insurance companies have the responsibility to ask the right questions. If hospitals are charging more or admitting a patient who may not require admission and who can be quarantined at home.
By raising the right questions, insurance companies help to modulate the healthcare economy. Otherwise, in unregulated healthcare services, if there is no regulation, they may charge right, left and centre and this will have a dent on the Indian healthcare economy. So, it is not that they are not paying, they are only questioning unjustified admissions.
Will insurers settle claims if one gets hospitalized due to covid after taking second vaccination?
A very small percentage of people do get infected after the first or second dose of vaccine. But for an insurer, it doesn’t matter, and we have to pay if the customer contracts a disease irrespective of his vaccine status.
Did you see any tapering effect in policy buying after the commencement of the vaccination process?
In proportion to the incidence of covid-19 cases identified, there is growth in the health insurance industry. During the second half of January and February, there was a decline. But now we see a good increase in the growth of health insurance. This scenario reflects the emotion towards buying health insurance and insurers make the best use of this opportunity which can prevent families from being pushed into poverty due to health reasons. Currently, due to the impact of this pandemic, we see a growth of around 40% in health insurance sale compared with last year.
What are people’s sentiments towards buying a health policy?
The majority of the people prefer buying general health policies compared with corona-specific policies. What we have witnessed is that the majority prefer buying disease-specific policies for their employees, maids, drivers, etc. It is generally bought for others.
But in general, buying a routine mediclaim policy, which covers all diseases, is anytime helpful. The pandemic is continuing beyond one-and-a-half years, and it is expected to continue for a longer time. Hence it is preferable to buy a routine mediclaim policy than a disease-specific policy.
If someone chooses a disease-specific product as they are priced less, it is better that they should look at a standard product like Arogya Sanjeevani and then after a few years they always have the option to migrate to a comprehensive health insurance policy.