Careless health insurance takers beware! 4 out of 10 claims are being canceled, know why?

Denied Health Insurance Claim: The number of people purchasing health insurance has skyrocketed during Covid. But many complaints are being received that claims are not being approved at the time of need. 4 out of every 10 health insurance holders are having their claims canceled in the last 3 years. A survey conducted by LocalCircles revealed that 43 per cent of health insurance holders' claims have been canceled during this period.

A survey released by LocalCircles said that insurance companies have canceled claims based on the condition that they approve claims only for a certain amount if the disease condition is classified as such. Additionally, many insurance holders wait for claims to be approved until the hospitalized patient is discharged as claim processing takes a long time. In many cases the claim approval process takes 10-12 hours longer than the time the patient is discharged. Due to which one has to face many problems.

As some part of the amount was approved, the burden of the bill increased

Since insurance companies initially approve a claim for a limited amount depending on the condition of the illness and take more time to complete the process, the bill is on the patient and his family in case of hospitalization after the discharge date. The burden has increased. In many cases the claim is being canceled on the grounds that the illness is not covered in the insurance policy.

This rule of Irdai will increase transparency but will not have any effect.

Despite Irdai's intervention in the matter, the attitude of insurance companies towards cancellation of claims has not changed. In the times of Covid and in a hurry, insurance companies have valid reasons to cancel the claim because the policy holder has not read all the terms and conditions of the health insurance or has purchased the insurance with incomplete information.

IRDAI requires all insurance companies to update details of claims received, canceled and accepted on their website every month. This increases transparency. Of the 5.5 lakh complaints pending with the Department of Consumer Affairs, 1.6 lakh cases are from the insurance sector.