Insights on health insurance claims: Survey reveals 94% of claims approved; customer satisfaction at 86%

A recent report by Policybazaar has revealed that 94% of health insurance claims are approved by insurance companies. The report further noted that the figure for claims initiated through online channels has climbed to 97%.

Along with this, the integration of online platforms results in a significant decrease in rejection rates, dropping from an average of 6% to just 2.5%.

Health insurance claims

Meanwhile, the claim payout amount stands at 87% while achieving the 100% feat remains a dream. This can be attained by enhancing awareness about add-ons like consumables cover. Similarly, the customer satisfaction area too requires improvement as the report highlighted that only 86% of customers reported satisfaction with their claim experiences.

Even with this high approval rate, a significant portion of the claim faces rejections which stands at 6%. As per the Policybazaar report, the rejection stem from non-disclosure of pre-existing or uncovered diseases.

Meanwhile, when customers resubmit rejected claims themselves, only 6% succeed in having their decisions reversed. However, this rate improves dramatically to 32% with the assistance of offline agents and jumps to 67% when utilising online intermediaries.

Cashless vs re-imbursement claims

As per the report, 70% of reimbursement claimants seek financial aid to cover upfront payments, indicating a reliance on out-of-pocket resources due to various factors such as the unavailability of cashless facilities or preferred healthcare providers not being in the insurer's network.

Also watch: IRDAI tweaks health insurance norms: Entry age to waiting period, here's how the changes will impact you