Kushal is fed up with his Health Insurer, so much so that he has vouched to not buy a policy ever again.
Three of his claims in the last two years have been rejected, and the reasons seem to be getting all the more creative - the first time his claim was rejected because apparently there was no active line of treatment, the second time during Covid, his Insurer rejected the claim because his policy didn't cover domiciliary hospitalization, and finally this time around he is being reimbursed ₹3 Lac when his claim was for ₹5 Lac; on enquiry, he is told the deduction is for Reasonable & Customary charges.
Did we touch a nerve there?
Kushal might come around someday, but the fact remains that claims processing is becoming an Achilles heel for Insurers - it is getting increasingly complicated, time consuming and process driven. The thrust on automation is pushing Insurers into a dark alley where they seem to be forgetting the fact that claims processing, the final frontier on which the Insurer would be judged, cannot be a binary function, especially since it involves dealing with people, at a time when they are going through crisis.
Well the good part is, this realization has prompted Insurers to put in their best talent in the claims processing vertical.
The smarter the Insurer, the better the quality of staff deputed in handling claims.
This comes from an inherent understanding of the fact that Claims processing is the लक्ष्मण रेखा, an Insurer does not want their Customers to breach, because once breached, the Customer will never come back, not only will she not come back, she might take away a couple of good Customers along.
It is not for nothing that Customer Relationship Management budgets have outgrown Customer Acquisition ones, over the last couple of decades.
The sad part is, that we seem light years from an easy and transparent mechanism to ensure easier, customized claims redressal.
A nightmare for you could be when the Insurer decides to bury you in long drawn technical paperwork which would not only be time consuming, but an emotional drain.
A simple solution to this nightmare is having an interface that isolates you from this charade.
Red Carpet Claims Assist (RCCA) is that interface.
About 3 minutes of your time with an RCCA agent and you are sorted. They take care of all the procedural, technical and most importantly the emotional burden.
Here's three reasons why you need an RCCA program -
1. The increasingly technical nature of claims processing makes liaising with the Insurer a complicated task.
Case in point - There are two claim forms that need to be filled out while filing for reimbursement. One of these needs to be attested by the Hospital. Imagine the amount of resources you would need to put to test to get the second form filled from the Hospital, especially since you are no longer an inpatient.
2. The loss of time haggling at the Hospital or with the Insurer comes at the expense of time that could have otherwise been put to productive use, at work, especially since you probably have already created a backlog tending to the hospitalization.
3. For all the thrust on automation, the document exchange between you and the Insured, seems to be on a piecemeal basis. The number of iterations between you and the Insurer seems more a matter of luck than technical prudence.
At some point in this pursuit, the target of your angst naturally shifts from the Insurer to the Industry - you paint the entire industry black and decide to never buy insurance again. While there could be some bad apples in the orchard, it is not completely ruined, we say it out of the experience.
Outsource this headache to a credible Third Party who specializes in dealing with such situations.
So how does RCCA work?
You give the Agency about 3 minutes of your time at the beginning of the process and then, sit back, wait for the amount to be credited to your account.
Here's how RCCA alleviates your woes
1. They know who to escalate to, and when, ensuring TATs are maintained.
2. Having been in the industry, RCCA Agents can foresee patterns and thereby take preemptive actions, as and when needed.
3. They relieve you of the procedural burden which could have transformed into mental agony if not tended to appropriately.
4. They make the process objective for you - you can sit back and immerse yourself in your work. The loop closes when money is credited to your account.
5. You don't need to keep revisiting the emotional trauma of hospitalization over and over again. Once you have outsourced this headache, you can sit back, relax, wait for the reimbursement credit to your account.
At Ethika, we understand risks; our Red Carpet Claims Assistance program has helped scores of Individuals get back to work sooner than they anticipated.
Author Bio
Susheel Agarwal, he is the CEO of Ethika Insurance Broking which is a new kind of insurance broker that combines technology and innovation to make employee health insurance simple, humane and proactive. In other words, employee health insurance covers not only sickness but employee wellbeing and happiness too. We provide tailor-made risk management solutions to
our customers thereby decreasing their risk in their organizations.
