As on November 3, insurance companies received claims of more than Rs 7,973 crore through 5.18 lakh applications and settled 3.97 lakh claims amounting to Rs 3,435 crore.
Even as the non-life insurance industry continues to see higher claims arising from Covid-19, insurers say hospitals have been passing on various charges that are not payable under the insurance contract. This issue has led to lower claim settlement.
As on November 3, insurance companies received claims of more than Rs 7,973 crore through 5.18 lakh applications and settled 3.97 lakh claims amounting to Rs 3,435 crore. “We have started seeing health providers (hospitals) charging costs such as disinfection charges, AC sanitisation charges, among others. But such charges are not payable under insurance contracts and we do not pay such charges to hospitals,” said a senior official of a leading insurance company.
There are other charges like biomedical disposal charge, which are charged by the hospitals. “It is the duty of hospital to dispose of biomedical waste, how can we pay such charges,” explained the official.
S Prakash, managing director at Star Health and Allied Insurance, said, “At one end, we are grateful to hospitals for saving lives but at other end, we are also watchful because not all hospitals follow the same standard of practices.”
Industry people said out of total claims, insurer are not paying 20-25% of charges on an average to hospitals. “In such cases, we ask policyholders to approach hospitals to reduce such charges. We have seen several hospitals waving those charges from policyholders,” said an official from another insurance company.
Insurance companies also said there are other reasons for disparity between claims settled and claims reported. Bhaskar Nerurkar, head – health claims at Bajaj Allianz General Insurance, said whenever the patient is admitted, the hospital tells them an expected cost which insurers have to approve, but that may not necessarily be the final billed amount. For instance, they may approve Rs 1.5 lakh and that’s what gets reported, but the patient gets discharged in 6-7 days and final bill may be lesser than the reported amount, say Rs 70,000, so they settle that amount fully.