Survey: 43% Face Difficulties with Health Insurance Claims Over Three Years

In a revealing survey conducted across India, it has emerged that nearly 43% of health insurance policyholders have faced hurdles in claim processing over the past three years. This survey, which garnered responses from over 39,000 individuals spanning 302 districts, highlights significant issues such as claim rejections, partial approvals, and delays in processing times. The findings underscore the challenges consumers face in navigating the health insurance landscape.

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The majority of respondents, at a staggering 93%, are calling for regulatory reforms. They suggest that insurance companies should be required to publish comprehensive data on claims and policy cancellations on their websites monthly. This demand comes in the wake of ongoing difficulties encountered by consumers, despite efforts by the Insurance Regulatory and Development Authority of India (IRDAI) to mitigate these issues.

Localcircles, the organization behind this survey, pointed out that the refusal of health insurance claims and policy cancellations by insurers are among the primary concerns for consumers. Policyholders have reported instances where their claims were denied on the grounds of pre-existing conditions or were only partially approved. Additionally, there have been reports of significant delays in discharge from hospitals due to prolonged claim processing times, with some cases taking between 10 to 12 hours after the patient was declared ready for discharge.

The survey also sheds light on how consumers purchase or renew general insurance policies. Findings indicate that 39% of individuals rely on agents for this purpose, while 40% use online aggregators. A smaller fraction, 14%, prefer to use the websites or apps of insurance companies directly.

This comprehensive survey reveals a pressing need for enhanced transparency and efficiency in health insurance claim processing. As consumers continue to navigate these challenges, the call for regulatory changes grows louder, highlighting a critical area for improvement in India's insurance sector.