Activists say hospitals tend to get claims fully settled because of relationship with insurers, but policyholders lack bargaining power.

 

 

One of the worst suspicions of insurance buyers has been confirmed. Data presented in court following a petition by an activist says claim payouts are far higher for cashless health covers than conventional reimbursement facility--where a patient's family has to fork out cash before recovering the money from insurers.

Cashless claim disbursal is nearly double that of reimbursement claim payouts in case of several ailments, say numbers disclosed by IRDAI to Bombay High Court. For instance, the average payout in 2013-14 for diseases of the circulatory system was `81,384 through cashless facility, but `38,048 through reimbursements.

Activists say reimbursement claims get partially settled as policyholders do not have the bargaining power, while hospitals get claims fully settled due to their relationship with insurers.

It was found that of 22 diseases, reimbursement is lower in all cases except mental disorder. Insurers, however, insist that this does not qualify as an appleto-apple comparison.

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