Financial Express

Hospitals expect insurance companies to understand their difficulties and pay for expenses incurred in full, whereas insurance companies have a feeling that some hospitals charge high just because insurers are paying.

The Covid-19 pandemic will not only boost sales of virus-specific products, but will also increase those of routine health insurance cover, says Dr S Prakash, managing director at Star Health and Allied Insurance. In an interview with Chirag Madia, he says there is a need to create a standardization of costs and procedures throughout the country.

Excerpts:

Q. The health insurance industry is witnessing a strong growth in premiums. Is it only due to the Covid?

Whenever there is outbreak of a pandemic, it results in accelerated health insurance growth. With every pandemic, there is a fear and people recognise the need for health insurance. This will not only increase sales of Covid-specific products, but also increase sale of routine health insurance cover. Comprehensive products are doing very well compared to other products. Star Health Insurance has grown by 46% in this period.

Q. Are more young people buying health insurance policies because of Covid?

Previously it was considered that people require insurance cover only when they become old, but Covid-19 has created a paradigm shift. We now see a sudden increase in the number of youngsters buying health insurance policies. If health insurance has to grow in a big way and further increase its penetration, young and healthy people should come forward and buy health insurance. If more youngsters buy health insurance, there are chances that the overall health premiums might also go down. This is because premiums are decided by the claims outgo, and if claims are lesser, premiums will fall.

Q. There are some concerns regarding hospitals charging more for insured patients and less from people without insurance for Covid treatment. What is your view?

In India, there are no regulators for hospitals and this puts a common man in difficulty to decide on the appropriate hospital for his treatment. Only a small percentage of hospitals charge exorbitantly from customers having insurance. Insurers and hospitals should align and keep patients as the centre of focus and win their trust and confidence. Currently in India, out-of-pocket expenditure is around 65%. In the near future, this should substantially be brought down by the active growth of health insurance.

Q. What are problems faced by insurance companies from the hospitals side?

Hospitals expect insurance companies to understand their difficulties and pay for expenses incurred in full, whereas insurance companies have a feeling that some hospitals charge high just because insurers are paying. The General Insurance Council is trying convince hospital associations regarding a uniform price. The point which is bothering insurance companies is that different hospitals charge differently for same treatment.

Q. How are you handling hospitals charging different rates?

We work on a long-term relation with hospitals. Majority of hospitals that are networked with us are rendering active cooperation and adhering to our payment structure. Sometimes our customers incur higher cost due to co-morbidity or complications. In that scenario, we study the reasons and if those reasons are valid, we pay the extra costs. If we find these not reasonable, we talk to the hospitals and find a way out to resolve the issues.

Q. Are non-Covid policyholders back for treatment?

Yes, in the last few weeks, there has been an increase in patients seeking general treatment. Since the outbreak of the pandemic, there was a lot of fear in reaching to hospitals, but now majority of the patients are willing to go hospitals.

Q. What kind of trends is Star Health and Allied Insurance witnessing in Covid claims?

Typically, there are three kinds of patients from where insurance companies are getting claims. First are those with mild symptoms wherein policyholders need to be under self-isolation. They can claim under home quarantine charges. Second and third categories are patients with moderate symptoms who require oxygen support or those who are severely ill and require ICU care. They incur a higher cost for treatment. As a company, we have received around 38,000 claims and approved about Rs 300 crore.