Health Insurance Woes: 43% of Claims Rejected or Partially Approved | Vantage with Palki Sharma

Our next story is for anyone who has tried to buy insurance, especially health insurance. Why do people buy insurance? Mostly for their peace of mind, to protect themselves against unexpected life events. But ask anyone who has tried to buy an insurance policy. They most likely tell you that it's a dreadful experience. You have to navigate confusing jargon and policy documents, hustle and endure a maze of fitness tests, and haggle with agents over every penny. The entire experience is stressful, to say the least. And to make matters worse, many Indians are struggling with their health insurance claims. Earlier this year, a survey came out, 39,000 Indians took part in it. They were asked about their health insurance, and if they had trouble with their claims, 39,000 Indians, 43% of them said they did, that their claims were either rejected or partially approved. And this even forced some patients to stay in hospital longer than was necessary. So what issues did these policyholders face? Well, there is a whole list. Lack of full disclosure about exclusions and ambiguity in contracts. Some claims were rejected due to pre-existing diseases, others over eligibility issues. So policyholders want more transparency from insurance companies. That's what more than 90% of the respondents said in the survey. They want a more transparent process. And these complaints are not new. The government of India is aware, and it has raised similar concerns in the past. Last year, they released an assessment. The government released an assessment. It focused on cases in consumer courts. The government looked into some 600,000 cases, some 6 lakh cases from the consumer court. Nearly one third of these were related to insurance companies. That's well over 1,60,000 cases. Most of them were about health and life insurance, and the issues were the same. Vague insurance contracts, refusal to cover pre-existing diseases, and lack of transparency by insurance intermediaries. The government also believes that insurance policies need to be more transparent, and they should be worded simply. India's insurance regulator has been looking into this. That's the IRDAI, the Insurance Regulatory and Development Authority of India. This year, it made some changes in regulation. The first was about cashless claims. Health insurers need to clear cashless claims in three hours now. Companies were asked to offer more choices to make it easier for senior citizens to get insurance too. They often find it hard to get insurance, mainly due to their age and due to pre-existing medical conditions. Companies do not like to insure the elderly. If they do, they charge exorbitant premiums. So, these moves by the regulator must be welcome. They're good moves, but they may not be enough, and I'll tell you why. 73% of Indians do not have any health insurance, 73% of the country. There is clearly room for growth. The industry is pushing the government. They want health insurance to become more accessible. Recently, the industry made a demand, lower the tax on insurance premiums. The GST applies here too, the goods and services tax. Right now, it is 18%. So, you pay an 18% GST on your insurance premium, an 18% tax. The industry wants it to be brought down to 5%. Reports say the government is considering this proposal. If implemented, insurance policies would become more affordable, and that should help. But again, we say, what's the point of getting an insurance if you cannot claim it during a crisis? If you're squeezed for premiums every year, but when you file a claim, you're turned away. In this day and age, health insurance is a necessity, but without strong regulation, customers will remain targets for exploitation. Across continents, one powerful news source. Bringing you diverse perspectives on the issues that matter. We go beyond the boundaries to give you that little extra about every sporting moment. So, thank you for making First Post 5 million strong. We're counting on your support, and you can trust us to bring you the news unfiltered and unvarnished. OneTree for a future. Project OneTree. A News80 network initiative.