A recent report by Policybazaar reveals that 94% of health insurance claims are approved by insurance companies, highlighting a robust performance within the industry. This approval rate climbs to an impressive 97% for claims initiated through online channels, showcasing the efficiency and transparency provided by digital platforms.
Decrease in Rejection Rates Through Online Platforms
The integration of online platforms significantly reduces rejection rates, with average rejections dropping from 6% to just 2.5%. This trend underscores the potential benefits of digital processes in the health insurance sector.
Claim Payouts and Customer Satisfaction
Although the approval rates are promising, the report points out that the claim payout amounts stand at 87%, leaving room for improvement. The goal is to reach a 100% payout rate, particularly by increasing awareness about additional coverages such as consumables cover.
Customer satisfaction is a critical metric for the health insurance landscape. According to the report, 86% of customers expressed satisfaction with their claim experiences. This positive feedback reflects the industry’s efforts to meet customer expectations and enhance trust in insurance providers.
Reasons for Claim Rejections
Despite high approval rates, claim rejections still occur, with 6% resulting from the non-disclosure of pre-existing or uncovered diseases. This finding highlights the need for clear communication between insurers and policyholders at the time of purchase to prevent such issues.
Role of Intermediaries in Claim Reversals
Intermediaries play a crucial role in the claims process. When customers resubmit rejected claims on their own, only 6% succeed in reversing the decision. However, this success rate improves to 32% with the help of offline agents and jumps to 67% when utilizing online intermediaries.
Cashless vs. Reimbursement Claims
The report also explores the dynamics of cashless and reimbursement claims. It finds that 70% of reimbursement claimants seek financial aid for upfront payments, indicating a dependence on out-of-pocket resources due to factors such as the unavailability of cashless facilities or non-network healthcare providers.
Opportunities for Improvement
Despite an 86% satisfaction rate, there is room for improvement in the health insurance claims process. Key strategies include expanding cashless claim availability beyond metropolitan areas, enhancing claims processing efficiency, and strengthening on-ground presence to provide psychological comfort to policyholders.
This comprehensive report by Policybazaar sheds light on the current state of health insurance claims, emphasizing both the strengths and areas for improvement within the industry.
