Medical insurance is an absolute necessity, given the exorbitant rise in healthcare costs and out-of-pocket expenses. However, a recent survey has highlighted a glaring challenge that mediclaim policyholders face while claiming health insurance returns. The survey found that health insurance companies are going about the processing of claims slowly, causing delays in hospital discharges, thereby forcing consumers to settle for lower claim settlements. According to Local Circles, an online social media platform that monitors citizens’ issues, which surveyed 28,700 respondents across 327 districts, six in 10 policyholders had to wait between six hours and two days for hospital discharge during the fiscal 2023-24. There is more. Fifty per cent of policyholders who have filed claims over the past three years have had their claims rejected or partially approved for what they believe are “invalid reasons”. Only 25% of respondents said that they experienced a hassle-free claim settlement process while 6% stated that the insurers approved their demand after some back and forth. Last year, the Insurance Regulatory and Development Authority of India had mandated that insurers must ensure that there is no delay in hospital discharges for patients. But is anyone listening? Worse, the IRDAI’s latest annual report shows that health insurers had outright denied Rs 15,100 crore worth of claims — 12.9% of the total claims filed — last year. The blatant attempt to delay the processing of claims seems to be a favourite — profitable — strategy for insurance companies: they eventually paid around Rs 83,000 crore of the total claim amount of Rs 1,17,000 crore in 2024.

Medical inflation in India is currently at 14%, which is the highest rate among Asian countries. Insurers indulging in malpractices will not only inconvenience consumers in a nation where private medical insurance is not exactly cheap but also deter others from purchasing medical coverage. Senior citizens dependent on paltry pensions are especially inconvenienced by such chicanery since access to healthcare and timely, full disposal of insurance claims remain crucial for them. A transparent, real-time tracking system for policyholders to keep tabs on the status of their claims is warranted. In this regard, the introduction of the National Health Claims Exchange, a fully digitised gateway for faster claim settlement, seems promising. The government should see to it that more insurers join this platform.