New Delhi: According to a survey conducted by insurer broker Secure Now, settlement of health insurance claims takes an average of 20-46 days from the date of intimation to the insurer.
Maternity claims take 7 to 108 days for insurers to settle, while those for caesarean section surgeries take 9 to 135 days. According to the survey findings, chemotherapy claims are usually settled between 12 and 35 days.
“Although it does not take long to notify the insurer for claim reimbursement when patients are admitted, the average time taken for settlement of claims by the insurer is much longer. In a typical claim processing timeline, the maximum time between intimation and settlement is is taken,” the survey said.
About 13-26% of the claimed amount is deducted from the final settlement amount as they are treated as “open consumables and administrative expenses”.
The survey said that maternity and chemotherapy have the highest hospitalization cost per day, while other viral infections including dengue and COVID have the longest hospitalization of 4-5 days.
Chemotherapy, according to the survey, “is surprisingly heavy on the pocket for the average person despite the patient’s stay being barely a day.”
It has been observed that public sector insurers are often able to negotiate hospitalization costs which are much lower than private sector insurers, sometimes up to 50%.
Under the General Insurance Public Sector Association, public sector insurers have significant benefits through lower hospitalization rates. This translates into lower claim costs and consequently lower premiums for group health insurance.
The survey states that the cost of claims can be reduced by 10-30% when insurance is purchased from public sector insurance companies.
Kapil Mehta, Co-Founder, Secure Now, said, “There are around 10 million health insurance claims every year. This in itself is an indication of how the health insurance industry has evolved. The next step is to publish detailed claims information. It highlights the strengths and improvement areas in settling claims. Our report is an important step in that direction.”