Six in 10 policyholders who claimed health insurance in the last three years made to wait up to 48 hours for discharge: LocalCircles

Six in ten surveyed policyholders who filed a claim with their health insurers in the past three years were required to wait between six and 48 hours before their claims were approved, allowing them to be discharged, according to a new survey by citizen engagement platform Localcircles released on Thursday. 

Despite the mandate of the Insurance Regulatory and Development Authority of India (IRDAI) to process a cashless claim immediately or at least within an hour of submission, only 8% of the 30,366 respondents said that their claims were processed instantly. Most of the respondents said that their claims were processed either within three to six hours, or within 24 to 48 hours, with these respondents making up 41% of the total respondents.

The survey also revealed that over five in ten policyholders who made a claim in the last three months also said that the insurance company rejected it or only partially approved it for invalid reasons. Out of the 28,700 responses received, 20% said that their claim was rejected for invalid reasons, and 33% of the respondents said that their claim was only partially approved for invalid reasons. 25% of the respondents said that their claim was fully approved.

Insurers are mostly sceptical of health insurance companies, with the survey claiming that over eight in ten surveyed insurers who submitted a claim in the last three years believe that the delay in claims is institutionalised to make the policyholders tired of waiting, and make them acquiesce to settle for a lower amount. Among the 27,371 respondents, only 7% believe that the scenario above is uncommon or unheard of. On the other hand, 47% of the respondents reported that it had happened to their family, whereas 34% of the respondents stated that it hadn’t happened to them, but had happened to someone in their close network.

The survey also highlights the belief among policyholders that health insurers still lack transparent, web-based communication systems, even for pre-approved cashless processing. Instead, they tend to rely on emails and calls from the hospital. Out of the 15,301 respondents, an overwhelming 83% stated that the lack of transparency and web-based communication systems is not currently happening, and IRDAI should mandate such systems.

Since June, the IRDAI has begun inspections, in a phased manner, of health insurers to verify whether the ilk is adhering to the new Health Insurance Master Circular, identifying compliance issues in claim settlement timelines and administrative norms among several claims. In June last year, after LocaCircles raised the issue, the IRDAI introduced a series of changes in the health insurance sector aimed at improving service standards. Yet, policyholder dissatisfaction with the way health insurance claims are processed persists. According to LocalCircles, social media platforms are rife with such grievances.