Five out of ten patients face delays in discharge from the hospitals due to the time taken to process medical insurance claims, reveals a new study by healthcare provider Pristyn Care.
The study also finds that over 40 per cent of individuals attribute delays in claims to hospital administrative processes, while 25% cite a lack of coordination between hospitals and insurance providers. “Complex documentation procedures also significantly contribute to these delays,” states the study.
“Six out of ten individuals never initiated the health insurance claim process. Among those who did, 34 per cent expressed dissatisfaction with the paperwork, while 40 per cent faced challenges in receiving timely responses from their insurance providers.” Roughly 3 out of 10 patients encountered discrepancies between pre-approved and final claim amounts. Additionally, around 38 per cent of respondents reported that the discharge process took over 8 hours, with hospitals requiring a similar time frame to process claims.
Commenting on the findings, Dr. Vaibhav Kapoor, co-founder of Pristyn Care, said, “There is a huge gap between the intended ease of cashless health insurance and the reality experienced by policyholders. Despite 75% of survey respondents having cashless insurance, a significant number still face challenges during the claim process. This creates additional stress for patients and families already dealing with a medical emergency.”
In order to alleviate the hassle experienced by health insurance policyholders, the Insurance Regulatory and Development Authority of India (IRDAI) is likely to introduce a 100% cashless hospital network that will include both empanelled and non-empanelled hospitals.
“It is encouraging to note that insurance providers have already started digitising and using tech to make the process quick and smooth. By embracing technological innovations, insurance providers are not only addressing the current challenges faced by policyholders but also paving the way for a more efficient and customer-centric insurance ecosystem,” Dr. Kapoor said. Quoting PwC, he said, it has been found that the use of AI and ML in claims processing can reduce the processing time by up to 90 per cent.
According to a IRDAI report, currently, cashless settlement services are accessible in 49% of hospitals in India. Both general and health insurance companies update their roster of affiliated hospitals in response to costly medical bills and false claims aimed at increasing payouts from insurers. To address these challenges, the insurance regulator, in collaboration with the General Insurance Council, aims to establish a nationwide common cashless hospital network. This initiative aims to expand and streamline the health insurance claims settlement process.
