Health insurance complaints have doubled in 6 years; why are cases increasing?
Health insurance has become commonplace after Covid, but a new problem has also emerged: when claims are delayed during treatment, people become increasingly worried. This is why complaints related to health insurance are rising rapidly.
Awareness about health insurance has increased more than ever in the country, especially after COVID. People are purchasing policies to avoid the high cost of medical treatment, but the number of complaints has also increased rapidly.
According to an ET report, data from the Mumbai Insurance Ombudsman's Office shows that health insurance-related complaints have nearly doubled in the last six years and today constitute the largest share of all insurance complaints.
How much have the complaints increased?
According to the Ombudsman's Office, while approximately 3,700 complaints related to health insurance were filed in 2020-21, this number exceeded 7,700 by 2023-24.
This trend continues in the current financial year. Health insurance has reached nearly 80 percent of total complaints, demonstrating the severity of the problem.
Insurance portability: Opportunity, but also confusion
Insurance portability, the ability to transfer a policy from one company to another, is beneficial for consumers. However, many times, people don't understand the terms and conditions that have changed in the new policy. This can lead to problems during claims due to old waiting periods or misunderstandings about coverage.
Impact of Insurance Settlement Swapping
In some cases, the settlement process between hospitals and insurance companies becomes complicated during treatment. Claims can be stuck if a patient changes network hospital or switches from a cashless to a reimbursement mode.
This settlement swapping can leave patients waiting for extended periods of time for their payments, leading to increased complaints.
What are the most common complaints?
The most common complaint in health insurance is related to claims. In many cases, the full claim amount is not received or the claim is rejected for one reason or another.
Companies often claim that the treatment was not necessary, hospitalization was not required, or that the treatment could have been performed in an outpatient setting. Claims are sometimes rejected based on a lack of a complete medical history.
There is no less controversy in life insurance also
Apart from health insurance, complaints also arise regarding life insurance. The biggest reason here is mis-selling. Customers are lured with the promise of high returns, but the terms and conditions later turn out to be different. Disputes arise due to a lack of accurate information about premiums, annuities, and benefits.
What is the way forward?
Experts believe that a separate regulator is needed for the healthcare sector. Insurance companies must simplify policy language and provide customers with complete honest medical information. Only informed consumers and a transparent system can curb these rising complaints.