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What can be improved about healthcare insurance in India

What can be improved about healthcare insurance in India

Addressing the challenges facing healthcare insurance in India requires a concerted effort towards transparency and efficiency.

Dr. Suman Katragadda, CEO of Heaps.ai
  • Updated May 17, 2024 6:49 PM IST
What can be improved about healthcare insurance in IndiaA recent survey by LocalCircles has unveiled substantial hurdles faced by policyholders when navigating the complexities of health insurance claims.

India, with its burgeoning population and diverse healthcare needs, grapples with the challenge of providing accessible and affordable healthcare services to all its citizens. Healthcare insurance plays a pivotal role in ensuring financial protection against medical expenses. However, recent revelations from a comprehensive survey conducted by LocalCircles have unveiled substantial hurdles faced by policyholders when navigating the complexities of health insurance claims. The insights garnered from this investigation shed light on critical areas where the Indian healthcare insurance sector can significantly enhance its operations to better serve the needs of its beneficiaries.

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Challenges in Healthcare Insurance in India 

A prominent challenge is the pervasive lack of transparency evident in insurance policies and claim processes. Policyholders often need help deciphering the intricate details of insurance contracts, resulting in confusion regarding coverage entitlements and reimbursement procedures. Moreover, pricing information for medical treatments and services should be clearly communicated to patients upfront, to avoid unexpected financial burdens. 

Another significant challenge unveiled pertains to the prevalence of claim rejections, primarily due to discrepancies in documentation and insufficient clarity in the claims process. Policyholders frequently encounter instances where their claims are denied or only partially approved, exacerbating financial strain and disillusionment.  As a result, policyholders may feel discouraged and overwhelmed by the process.

Solutions for Enhancing Healthcare Insurance in India

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A crucial step towards enhancement entails the implementation of rigorous transparency within the healthcare insurance system. This transparency ensures that patients are fully informed about their insurance coverage, including pre-existing conditions and any potential limitations. By fostering clear communication between patients, hospitals, and insurance providers, individuals can make more informed decisions about their healthcare needs. Moreover, transparent policies prevent exploitation by hospitals, ensuring that patients are not burdened with unforeseen financial liabilities. 

Furthermore, the integration of Gen AI offers a promising avenue for optimising healthcare operations. Through automated content generation, it customises information for patients, thereby enhancing their engagement and clearly listing out what is included and not included in the claims forms. Employing Gen AI, the system tailors insurance plans to the unique requirements of each individual, alleviating the burden of manual contract management. This innovative strategy fosters transparency, enabling patients to grasp the extent of their coverage and mitigating potential exploitation by healthcare institutions. The simplicity and effectiveness of Gen AI empower patients, hospitals, and insurance companies to forge collaborative partnerships, leading to tangible enhancements in healthcare delivery and outcomes. 

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In conclusion, Addressing the challenges facing healthcare insurance in India requires a concerted effort towards transparency and efficiency. Clear communication of policy details, streamlined claim processes, and innovative solutions like Gen AI can empower stakeholders to navigate the system effectively. By prioritising these improvements, the Indian healthcare insurance sector can better serve its citizens and ensure equitable access to quality care.

The author is the CEO of healthtech startup Heaps.ai 

Published on: May 17, 2024 6:49 PM IST
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