News ki Pathshala : Why pay out of pocket even after insurance? Why pay out of pocket even after insurance? class of those who collect your money

The job of insurance companies is to insure so much that your money gets in their account, just make sure that. If you do not get the facility after that, it is not their headache. During the second wave of Corona, huge bills were made for treatment. Hospitals looted. Insurance companies are not clearing the claims. The Kovid Victim Family is stuck in debt. First fight with Corona then fight with the system
The question is, why pay out of pocket even after insurance?

According to a report, insurance companies will have to

Claim – 9,86, 366
Price- 14560 Crore
Rejected – 41,763
Reject Claim Value – 361 Crore
Pending Claim- 95, 569
Price – Rs 6366 crore

2021 (April to July)

Claim- 12, 29, 538
Price- 13894 crores
Rejected – 49452
Reject Claim Value – 389 Crore
Pending claim – 3 lakh 31 thousand 82
Price- Rs 10603 crore

Insurance companies stuck Kovid claims!

3,30,000 Claims
Rs 10,603 crore

In April, an order of the Delhi High Court came. The court had asked the insurance regulator IRDA to issue directions to the insurance companies. Clear the bills of corona patients in 30 to 60 minutes. It shouldn’t take 6-7 hours for the bill to be approved. On this, IRDA had given instructions to the insurance companies. Settle the claims of Kovid case within an hour. But here the claims are pending for three-three, four-four months. The Delhi High Court had said that IRDA should issue instructions to insurance companies that the bills of Kovid patients should be passed in 60 minutes. Can’t take 6-7 hours to clear the bill. IRDA’s instructions on the order of the High Court, insurance companies should settle the claim in 1 hour.

Insurance companies are not passing claims easily. People are getting upset, they got treatment by taking loan. Big bills get stuck by the insurance company. Fixed insurance policies had a one-time payment. That is not happening. We have spoken to many families. A victim said that when I got corona, I made a claim, but by making the opposite excuse, my claim was made a no claim. These companies are not doing it right. Why sell policies, why fool the public.

People’s savings were over in the second wave of Corona. Had to borrow for treatment, had to sell jewelry for treatment. Jewelry had to be mortgaged for treatment. Let me tell you one more figure. PF money is for retirement. People had to withdraw PF money. From April last year to May this year, 72 lakh people had withdrawn 18 and a half thousand crores from PF as Kovid Advance. So far, 3.5 crore people have withdrawn about one lakh 25 thousand crore rupees from PF in the entire Kovid period.

On what basis are insurance companies rejecting Covid claims?

1- RT-PCR report negative
2- If the CT scan score is up to 8
3- There was no need to be admitted
4- When the oxygen level is 94 or above.
5- In case of co-morbidity.
6- The absence of corona in the listed diseases of the policy.

But we talked to the doctors on this. Based on that conversation, we came to know about it.

It is arbitrary to reject the claim on the basis of 1-CT value, oxygen level.
2- About 30% such patients were admitted, whose CT value is less than 8.
Patients with higher oxygen levels were also admitted.
4- Seeing the condition of the patients, doctors advise to admit.

Arguments of insurance companies for not paying claims

1- RT-PCR report negative.
2- CT scan score of 8 or less.
3- There was no need to be admitted.
4-Oxygen level 94 or above.
5- In case of co-morbidity.
6- No corona in listed diseases.

Insurance claim is paid in two ways.

first is cashless
In which the insurance company pays the bill directly on going to the hospital
another way
You fill the bill yourself and pay it from the insurance company.
The second wave of the Corona period forced hospitals to refuse cashless.
Insurance companies were also ignoring

For this reason, Finance Minister Nirmala Sitharaman spoke to the Chairman of IRDA on July 22 and said that immediate action should be taken on this.

During the Corona period, people bought a lot of insurance policies, according to an estimate, 30% more policies were sold, the value of the shares of insurance companies increased, but now the insurance companies are not clearing the claim. Insurance premium increased by 10%.

There are 58 insurance companies in the country.
In this 24 companies are life insurers.
34 companies are non-life insurers.
The market for insurance products is about 7 lakh 60 thousand crores.
23 private life insurance companies have taken a premium of Rs 52 thousand 725 crore from April to June this year.

Companies taking precautions due to Corona

Due to the increase in corona cases and deaths due to this, insurance companies are now taking precautions and some of them have started asking for vaccination certificates and medical examinations have also been tightened. Policybazaar.com head (term insurance) Sajja Praveen Choudhary says that there is no clarity about the health condition after recovery from corona, so companies are careful in selling policies to such people. People who have recovered from corona may take time to buy a term life insurance policy as companies are being careful in selling this policy to those who or whose family has had a corona patient in the last six months.

According to Subhrajit Mukhopadhyay, executive director of Edelweiss Tokio Life Insurance, insurance companies are taking precautions due to Corona, but people are not trying to get out of their homes and get medical tests done. In such a situation, insurance companies are finding it difficult to sell policies without assessing the risk in the absence of new medical reports. According to a survey, 23% of the people took loans / loans to run the house in the era of Kovid. 5% of the people sold the land. 7% sold jewelry. 8% sold valuables.