Constantly increasing health insurance premiums, long time taken for claims to pass and huge arbitrary hospital bills. If you have ever faced a medical emergency for yourself or your family, you will be well aware of these complexities of the insurance system. When a policyholder is most helpless and stressed during illness, he has to bear the brunt of these structural deficiencies at the hospital billing desk. Now there is hope for a big and positive change in this system. Taking serious note of these ground and day-to-day problems of the policyholders, Insurance Regulatory and Development Authority of India (IRDAI), the regulator of the insurance sector, has constituted a new sub-committee. Its direct objective is to make your health insurance easier, more transparent and work without any interruption in times of crisis.
The arbitrariness of hospitals will be curbed
It is a common complaint that as soon as the hospital finds out that the patient has health insurance, the bill figure suddenly increases. The first thing on the radar of this new committee of IRDAI is ‘hospital tariffs’ and their billing procedures. The regulator is probing in depth why the cost of treating the same disease varies so much in different hospitals in the same city or in the same network. According to Rakesh Goyal, Managing Director of Probus, the biggest problem at present is that people feel that because they have insurance, they are being charged more money. The main work of the new committee is to correct the discrepancies in these tariffs and the network of hospitals. Its direct benefit will be that treatment prices will become logical and there will be uniformity in billing.
Now there will be no hassle of waiting for claim settlement
Unnecessary delays in claim settlement, lack of transparency regarding terms and conditions and ignoring of complaints are the reasons which have weakened customer trust in the entire system. To overcome these shortcomings, the regulator is working towards large-scale adoption and implementation of digital platforms like National Health Claims Exchange (NHCX). Along with this, strict steps are being taken to prevent fraud and eliminate administrative delays.
Important suggestions of the working group of Confederation of Indian Industry (CII) will also be included in the action plan of this new committee. In this, there is a big proposal to implement a ‘Joint Code of Conduct’ between insurance companies and hospitals. If this is successfully implemented, the disputes arising at the billing desk will be resolved immediately and the process of getting the patient discharged from the hospital will become very easy and fast.
What will be the impact on policies?
Arun Ramamurthy, co-founder of Staywell.Health, says that this step of IRDAI has two main objectives. First, to ensure the reach of health insurance to as many people as possible and second, to make it very simple and convenient for the common consumers.
The ultimate and biggest objective of this entire exercise is to keep the premium prices stable and affordable for a long period. Instead of policies with heavy words and legal complications, work is now being done on a ‘Basic Product’ framework that any common man can understand without the help of an agent. By syncing private insurance with government health schemes, portability will also become easier than before. Medical inflation and claim trends are being analyzed closely so that premiums do not increase suddenly in future.