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NEW DELHI: Settlement of health insurance claims on an average takes 20-46 days from the date of intimation to the insurer, as per a survey conducted by insurer broker SecureNow.
For maternity claims, insurance companies take between 7 to 108 days to settle, while those related to caesarean section surgeries take 9 to 135 days. Chemotherapy claims are typically settled between 12 and 35 days, as per the survey findings.
“While patients don’t take a lot of time intimating the insurer for a claim reimbursement upon being admitted, the average time for an insurer to settle the claims is way higher. In a typical claims processing timeline, the maximum time is taken between intimation and settlement," the survey said.
About 13-26% of the claimed amount is deducted from the final settlement amount as they are deemed “uncovered consumables and administrative expenses".
The survey said maternity and chemotherapy have the highest per-day hospitalisation costs, while dengue and other viral infections, including Covid, have the longest hospitalisation of 4-5 days.
Chemotherapy, according to the survey, “unsurprisingly, is very heavy on pockets for an average person despite the duration of stay for the patient being hardly a day."
It observed that public sector insurers are often able to negotiate hospitalisation costs that are significantly lower than private sector insurers, sometimes by as much as 50%.
Public sector insurers under the General Insurance Public Sector Association have a significant advantage through lower hospital rates. This translates into lower claim costs for group health insurance and consequently lower premiums.
Claims cost could be 10-30% lower when insurance is bought from public sector insurers, said the survey.
Kapil Mehta, co-founder of SecureNow, said, “There are close to 10 million health insurance claims each year. This in itself is a sign of how the health insurance industry has evolved. The next step is to publish detailed claims information. This shines a light on the strengths and improvement areas in settling claims. Our report is an important step in that direction."