A nationwide survey has found that six in ten health insurance policyholders had to wait 6 to 48 hours for hospital discharge, bolstering concerns about companies stalling claim processing to pressure claimants into accepting lower settlements.
The survey by LocalCircles, an online social media platform tracking citizens’ concerns, has also found that 8 in 10 respondents believe that claims are intentionally delayed so that policyholders get tired of waiting and accept lower claim amounts.
The Insurance Regulatory and Development Authority of India (IRDAI) had in a May 2024 circular specified that insurers should grant final authorisation for hospital discharge within three hours of receiving the discharge authorisation request from the hospital.
Health insurers had during fiscal 2023-24 disallowed outright ₹15,100 crore worth of claims, or 12.9 per cent of the total claims filed, according to the IRDAI’s latest annual report. Added to this was partial approvals, which meant the insurers eventually paid only ₹83,493 crore (71.29 per cent) of the total claim amount of ₹117,000 crore during the year.
Five in 10 health insurance policyholders who had filed claims over the past three years have now told the LocalCircles survey that they had their claims rejected or only partially approved for what they believe were invalid reasons.
Among 28,700 survey respondents from 327 districts across India, around 20 per cent said their claims were rejected with invalid reasons and 33 per cent said their claims were partially approved, with invalid reasons offered for the amounts unpaid.
Only 25 per cent said their claims were fully approved without trouble, while another 6 per cent had their claims fully approved “after some back-and-forth” with the insurers.
Among 30,300 health insurance policyholders who responded to a question about their wait for hospital discharge, 21 per cent said the claim settlement process took 24 to 48 hours, 12 per cent said the process took 12 to 24 hours, and 14 per cent said it took nine to 12 hours.
Only eight per cent said the discharge was processed instantaneously and 12 per cent said it took one to three hours.
“The IRDAI has asserted that there should be no delays in the discharge, but we find that this is not happening. Delays are widespread,” said Sachin Taparia, founding director ofLocalCircles.
Among the 27,000-plus respondents asked whether they thought such delays worked in favour of the insurance companies, 80 per cent said they suspected the delays were intentional, designed to frustrate policyholders into accepting lower settlement amounts.
Nearly 47 per cent said they had themselves experienced such delays, accepted lower claim amounts, and paid the balance out of their own pockets.
“Those who have filed health insurance claims are reporting on LocalCircles that the process of claim submissions between hospitals and companies is based on emails with follow-up phone calls,” Taparia said.
“What policyholders want is a transparent, real-time tracking system that keeps them updated on the communication between hospitals and insurance companies.”
Taparia said LocalCircles would share the survey findings with the IRDAI for policy interventions aimed at faster and more transparent processing of claims.
