The Daily Brief Hidden Traps in Health Insurance Claims!
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Mar 28, 2025 Discover the hidden traps of health insurance claims in India, where high rejection rates and miscommunication leave policyholders frustrated. Learn about the contentious 'reasonable and customary charges' clause that complicates claims even further. Plus, explore the RBI's upcoming changes to Priority Sector Lending, aimed at boosting finance access in crucial sectors like affordable housing and renewable energy. This mix of transparency issues and financial policy updates is both eye-opening and essential for navigating today's economic landscape.
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Health Insurance Claim Issues
- Health insurance claims can be stressful and often get rejected or reduced.
- The IRDAI found serious lapses in Star Health's claim settlement process, highlighting this widespread problem.
Complexity of Health Insurance
- Life insurance claims are straightforward, resulting in high settlement ratios (above 95%).
- Health insurance is trickier, with only 71% of claimed amounts paid out, 22% denied, and 6% pending.
Claim Rejection Reasons
- Advisors may misinterpret policy details, leading to claim rejection due to information mismatch.
- Third-party administrators (TPAs) prioritize speed and volume over customer satisfaction, potentially overlooking important details.