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Surge in claims for health insurers continues even after COVID second wave

S Prakash rise in claims health insurance Star Health

Health insurers in the country continue to see heavy claims despite the abatement of the second wave of the Covid19 pandemic. Star Health Insurance, one of the leading health insurance players, is receiving 4,000-6,000 claims per day across the country, said Dr. S Prakash, MD, Star Health Insurance.

Stark rise in claims from non-Covid Hospitalization Bills

Insurance companies are seeing a heavy load of claims, but not from COVID-related admissions. They pertain to planned procedures that people kept postponing over the past one year given the COVID imposed restrictions.

“COVID claims peaked in May 2021, but now, 70-75% claims are for non-COVID related interventions. We are receiving 4,000-6,000 claims per day across the country.”

The insurance industry is, in fact, seeing a flood of reimbursement claims related to Covid-19 and for planned surgeries. According to recent reports, insurers have received about 19.11 lakh Covid related health claims and have settled claims worth over Rs 15,000 crore upto June 22.

“The reimbursement claims for planned procedures reached a peak in October and November 2020 and has been steady henceforth.” Prakash added

Insurers are also seeing cases of post-Covid complications but they are relatively less in number.

 “The complications that arise post contracting COVID 19 are not that rampant in most of the people suffering from the virus. Children, however, seem to be more susceptible to multi-system inflammatory response syndrome after getting treated for COVID 19,” said Dr. Prakash.

“The other complications are recurrent pneumonitis, breathing problems, uncontrolled diabetic complications post covid, in some cases even memory fog and loss of smell and taste for a prolonged duration. However, the insurance industry is not seeing high volume claims from post COVID complications,” he added.


Post covid claims star health insurance

Prakash added that the post covid complications are covered under health insurance schemes offered by Star Health and there are no covid specific ‘exclusions’. He also said that for prolonged admissions, they ask for the discharge summary and study the co-morbidities. Additionally, Prakash said that Star Health follows the ICMR and AIIMS guidelines and insists that all hospitals also follow these guidelines. Hence, while tests such as CBC, IG Antibody, D Dimer, Chest Scans are covered, repeated tests maybe questioned by the insurer. “The repeated usage of tests when all the parameters are normal maybe questioned as it is important to maintain discipline for all the stakeholders,” he added.

Group health insurance portfolios for insurers continue to report high loss ratios, given low premium vs coverage co-relation, said Prakash with COVID related admissions continuing to dominate group health claims.

Rise in Fraudulent Claims

Unfortunately, during the pandemic, the health insurance industry has also seen a surge in frauds. “Even when it is time to show solidarity and empathy, we are seeing a tremendous increase in the number of fraudulent claims from various sources in the distribution chain – sometimes from intermediaries, or from hospitals and even in cases from customers,” he says

“In the past few months we have blacklisted around 100 hospitals from where the fraud cases are rampant,” said Prakash.

For insurers, the silver lining from the pandemic despite seeing a surge in volume of claims is the increasing awareness on the importance of health insurance. In the first quarter Q1 FY22, the general insurance industry has seen around a 34 per cent growth in health insurance even as other segments such as motor insurance have seen negative growth. Star Health has seen a surge in growth at around 51 per cent in Q1FY22.  “We are committed to translating the health insurance into better services and products to our customers along with raising awareness to further increase insurance penetration in India,” said Dr. Prakash.

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