Health insurers take 20-46 days to settle patients' claims: Report

Settlement of expense reimbursement claims under health insurance policies on an average takes about 20 to 46 days from the date of intimation to the insurer, said a study conducted by insurtech platform SecureNow.

The company said the industry data tabulated by it also shows that patients are quite prompt in informing the insurers about claims with most of them intimating the concerned insurance firms within a week of hospitalisation.

"However, on the other hand, the insurance companies take on an average between 7 to 108 days to settle the claims related to maternity. Caesarean sections take the longest time 9 to 135 days and chemotherapy the shortest period 12 to 35 days," the insurance broker said.

SecureNow said the data makes it clear that "while patients do not take a lot of time in intimating the insurer for a claim reimbursement upon being admitted, the average time for an insurer to settle the claims is way longer. In a typical claim processing timeline, the maximum time is taken between intimation and settlement."

Kapil Mehta, co-founder of SecureNow, said there are close to 10 million health insurance claims each year.

"This in itself is a sign of how the health insurance industry has evolved. The next step is to publish detailed claims information. This shines a light on the strengths and improvement areas in settling claims. Our report is an important step in that direction," he said.

According to the study, about 13 to 26 per cent of the claimed amount is deducted from the final approved claims on account of "uncovered consumables and administrative expenses".

About the cost and duration of hospitalisation, the survey said that maternity and chemotherapy cases have the highest per-day hospitalisation costs, while dengue and other viral infections, including COVID-19, have the longest hospitalisation of 4 to 5 days.

Public sector insurers under the General Insurance Public Sector Association (GIPSA) get some advantage in terms of lower hospital rates, the company said. This translates into lower claim costs for group health insurance and consequently lower premiums.

The claim cost could be 10 to 30 per cent cheaper when the insurance is bought from public sector insurers that have GIPSA rates compared to the service provided by private insurance firms, it said.

The SecureNow Group consists of SecureNow TechServices Pvt Ltd and SecureNow Insurance Broker Pvt Ltd -- an insurance broker focused on selling commercial insurances to SMEs (Small and Medium Enterprises) and mid-market clients.