Health insurance industry exposed! Here’s what policyholders get from insurers against lofty promises, reveals survey  

Do health insurers provide what they promise to policyholders? A survey has revealed that nearly 43% of health insurance policyholders have faced difficulties in getting their claims processed over the last three years. These policyholders mentioned challenges such as rejection of claims, partial approvals, and delays in the claim process.

In the survey by Localcircles, more than 39,000 respondents hailing from 302 districts in the country participated.

93% of survey respondents seek reforms in regulations

A majority of 93% of survey respondents sought reforms on the regulatory front. They opined that insurance companies should publish comprehensive data on claims and policy cancellations on their websites every month.

It assumes significance as the demand has been raised in the wake of ongoing difficulties faced by consumers, despite steps by the Insurance Regulatory and Development Authority of India (IRDAI) to sort out these issues.

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Major issues faced by health insurance consumers

The survey further said that rejection of health insurance claims and cancellation of policies by insurance companies were among the top issues faced by consumers.

Among other challenges faced by consumers was insurance companies rejecting claims by classifying a health condition as a pre-existing condition and then approving a partial amount.

“In several cases cited by policyholders, it took 10-12 hours after the patient was ready for discharge for them to actually get discharged because the health insurance claim was still getting processed,” the Localcircles survey said.

The survey also mentioned respondents citing significant delays in hospital discharge due to prolonged claim processing times, with instances taking between 10 to 12 hours after patients were declared ready for discharge.

The survey findings suggest that 39% of people rely on agents for purchase or renew general insurance policies. About 40% people use online aggregators, and a smaller fraction, 14%, prefer to use the websites or apps of insurance companies directly.

This survey underscores the pressing need for enhanced transparency and efficiency in health insurance claim processing. As consumers grapple with these challenges, the call for regulatory changes has grown. The survey stressed upon a need for improvement in India’s insurance sector.