How do I navigate 100% bill payment?

The pandemic has re-emphasized the importance of health care and individuals have started to pay more attention to understanding the various aspects of health insurance. When thinking about purchasing the policy, the obvious focus is usually on the coverage benefits and related features. What is missing, however, is – what expenses will be paid and what will be excluded at the time of claim.

Many non-medical expenses associated with hospitalization are usually not covered by health insurance policies in India.

Non-reimbursable expenses in health insurance contracts

Some of the most common non-reimbursable expenses that are not covered by traditional health insurance products in India include consumable items such as syringes, gloves, dressings and bandages or even essential items like oxygen masks .

Additionally, some hospitals may charge patients for administrative costs such as medical records or registration that are not covered by traditional health insurance policies. Then there are attendant fees where the cost of hiring one may not be covered by the health insurance policy.

There are approximately 68 items that may seem inexpensive, but can add up to a considerable amount in the overall hospital bill. These items typically represent 5-15% of the invoice amount and in some cases, particularly during the rise in covid cases, have reached 20-25% of the invoice amount.

What does 100% payment of the health insurance bill mean?

The term “100% bill payment” means that the insurance company will pay the entire hospital bill incurred by the policyholder, subject to the sum insured, without any out-of-pocket expense to the policyholder. insurance for medical expenses.

What can insurers do to ensure 100% payment of bills in the healthcare ecosystem?

There are many discrepancies in the healthcare industry regarding protocols for the use of consumables.

Insurance companies and hospitals need to come together and agree on standard procedural level protocols for the use of these items.

Although some insurers may be willing to cover these items on a pricing basis if there is predictability to these expenses. Some have taken measures, especially post-covid, to cover certain consumables by establishing a specific list for the company concerned. This is a good start to provide a better customer experience for claim-time deductions, which is the critical time test for the health insurance policy.

Plus, it provides peace of mind for customers that they won’t have to worry about separate headers about what’s covered and what’s not.

In conclusion, 100% bill payment is a valuable benefit that comes with cashless health insurance policies. It ensures that the insured does not have to worry about paying for hospitalization costs out of pocket.

However, it is essential to read the policy documents carefully and understand the terms and conditions before purchasing a health insurance policy. It will help you make an informed decision and choose a policy that meets your health care needs.

With the continued goal of supporting customers through their end-to-end healthcare journey, insurance companies should collectively take the approach on how best to cover approximately 100% of bills by defining reasonable expenses for a procedure or hospitalization.

-The author is VP – Retail Health, ACKO. The opinions expressed are personal.

Disclaimer:The opinions expressed in this article are those of the author and do not represent the position of this publication.

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