Getting Health insurance in India is simple and quick but these providers act as culprits of the industry as well. The agents of these companies play a negative role by not providing sufficient information or sometimes providing wrong information for the sake of their own incentives which is the main problem associated with this sector. Health care in India has witnessed greater importance during the past decade and same is bound to rise more with time. With its growing prominence and becoming a necessity, a problem has emerged that cost of a quality health care has also gone up due to which many people are not able to afford it. Many people trying to get their health risks cover with the help of health insurance also become victims of the problems within the insurance sector. There are potentially high gains for the insurance provider as well as insurance buyer with high stakes for both the players.
But following listed problems make people vulnerable to frauds and ineffective medical care: Third party administrators: The inability of third party administrators to pay and reimburse for the expenses to the policy holder is the biggest problem faced by Indian health insurance industry. Most of the insurance companies take services of third party to take care of reimbursements to be provided to insurance holders and even for cashless hospitalizations as well. Many hospitals do not offer cashless treatment facilities due to same reason as this problem delays in settlement of claims.
Hospitals: Indian medical and health care system has evolved immensely over the years. Many hospitals have increased their penetration with improved and genuine health care facilities. But these hospitals are also one of the factors becoming hindrance in the development of Indian health insurance industry. Many of these hospitals charge more in case a patient holds an insurance policy which in turn increases burden on insurance provider. The increased burden leads to higher payouts for the insurance company which is passed on to buyers by charging more for health insurance policies. This increase is more than the rise in the cost of medical care. Other problem with the hospitals is the misuse of group insurance policies of the hospitals which can be attributed to ignorance among policy holders. Many of the beneficiaries are either not registered or their identity cards are without proof which leads to more money charged by hospitals.
Policy holders or actual users: Many policy holders do not read policy documents carefully which includes inclusions and exclusions in insurance policy. Furthermore, many individuals take insurance policies at the time of treatment or after the diagnosis of their disease. This plays in the hands of insurance providers as many of them do not provide cover for pre-existing diseases in a default policy. This clause is generally provided as an add on by the insurance providers and above it, there are certain limits for the treatment of pre-existing and critical diseases which is also an optional cover. So, due to this ignorance, patients or policy holders are required to pay by themselves due to which their insurance policy becomes ineffective.
Insurance providers: There are over two dozen insurance companies providing health insurance in India but these providers act as culprits of the industry as well. the agents of these companies play a negative role by not providing sufficient information or sometimes providing wrong information for the sake of their own incentives which is the main problem associated with this sector.