Health insurance complaints
Awareness regarding health insurance in the country has increased more than ever, especially after Covid. People are taking policies to avoid heavy treatment expenses, but along with this the number of complaints has also increased rapidly. According to an ET report, data from the Mumbai Insurance Ombudsman office shows that complaints related to health insurance have almost doubled in the last six years and today it has become the largest share of all insurance complaints.
How much have the complaints increased?
According to the Ombudsman Office, while around 3,700 complaints related to health insurance were registered in 2020-21, by 2023-24 this number has crossed 7,700. The same trend continues in the current financial year also. The share of health insurance in the total complaints has reached almost 80 percent, which shows how serious the problem has become.
Insurance portability: opportunity, but also confusion
Insurance portability i.e. the facility to transfer the policy from one company to another is beneficial for the consumers. But many times people are not able to understand which conditions have changed in the new policy. Due to this, misunderstanding regarding the older waiting period or coverage creates problems at the time of claim.
Effect of insurance settlement swapping
In some cases, the settlement process between the hospital and the insurance companies during treatment becomes complicated. Claim may get stuck due to change of network hospital or switching from cashless to reimbursement mode. Due to this settlement swapping, the patient has to wait for the money after the treatment for a long time, which increases the complaints.
What are the most common complaints?
Most of the complaints in health insurance are related to claims. In many cases, the claim amount is not received in full or the claim is rejected due to some reason or the other. Often companies say that there was no need for treatment, hospitalization was not necessary or the treatment could have been done in OPD. Many times claims are rejected on the basis of not providing complete medical history.
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There is no less controversy in life insurance also
Apart from health insurance, complaints also arise in life insurance. The biggest reason here is mis-selling. The policy is sold to the customers by luring them with higher returns, but later the terms turn out to be different. Disputes arise due to lack of correct information about premium, annuity and benefits.
What is the way forward?
Experts believe that a separate regulator is needed for the healthcare sector. Also, insurance companies will have to simplify the policy language and provide medical information to the customers with complete honesty. Only aware customers and transparent system can control these increasing complaints.