MUMBAI, May 2 : Almost 43 per cent health insurance policyholders have experienced difficulties in getting their claims processed in the last three years, a survey has found.
The survey involving more than 39,000 respondents hailing from 302 districts in the country pointed out that the challenges include rejection of claims, partial approvals, and the long time taken to process them.
A majority of 93 per cent of respondents in the survey by Localcircles advocated for changes on the regulatory front, including mandating insurance companies to disclose detailed claims and policy cancellation data on their websites each month.
“Despite some interventions by the Insurance Regulatory and Development Authority of India (Irdai) consumers continue to grapple with insurance companies to get their health claims,” Localcircles said in a statement.
It pointed to rejection of health insurance claims, including “cancellation of policies” by insurance companies as the top issues faced by consumers.
Challenges faced ranged from insurance companies rejecting claims by classifying a health condition as a pre-existing condition to only approving a partial amount.
“In several cases cited by policy holders, it took 10-12 hours after the patient was ready for discharge for them to actually get discharged because the health insurance claim was still getting processed,” it said.
The survey said 39 per cent of those buying or renewing general insurance policies do so through an agent, 40 per cent depend on online aggregators and 14 per cent through websites or apps of insurance companies. (PTI)
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