COVID claims are rising. PPE kits are vital for the safety of patients and the medical staff who attend to them, so differences with hospitals over charges are resolved through discussions, United India Insurance Chairman and Managing Director Girish Radhakrishnan tells Preeti Kulkarni in this exclusive interview. Excerpts:
What has United India’s experience of managing COVID-19 claims been during the last three months?
COVID-19 has been a classic black-swan event that has caught everyone by surprise. The insurance sector is no exception to this. Our health teams have been working both from home and, wherever possible, from offices. They have been co-ordinating with our 17 third party administrators (TPAs) to ensure that all COVID-19 treatment claims are settled either in real time through the cashless route or via quick reimbursements. Both policy issue protocols and claim settlement workflows have been amended and adapted to make these as digitalised as possible. This has ensured that cashless approvals are processed within two hours, sometimes even based on documents sent through WhatsApp from hospital reception desks.
How many COVID-19 claims have you received and settled so far?
We have received over 7,000 claims to date, including 4,000 under the state government schemes in Maharashtra and Tamil Nadu, both of which we run. From the last few days of March to date, we have paid out over Rs 30 crore as COVID-19 claims
Differences of opinion between hospitals and insurers on billing PPE kits, other consumables as also fumigation and sanitisation charges have resulted in partial COVID-19 claim settlement for many policyholders. How have you processed such claims so far?
PPE is a new term in health insurance. But its use, along with some enhanced usage of certain other consumables, has become an integral part of COVID-19 treatment. We recognise that these are vital for the safety of both patients and the medical staff. We take care to walk the fine line when issues of overbilling for these items come up and our networking team members hold discussions with hospitals. This is aimed at reducing the burden on patients when we are compelled to cap the amount we can allow under this head. The majority of our claims come through our network hospitals and this considerably eases the negotiation climate (with hospitals). Also, PPE billing, which was on an average approximately Rs 4,000 per day, has now come down to below Rs 3,000.
Are you seeking standardisation of hospital charges for COVID-19 treatment? What kind the kind of standardisation you are looking for?
Yes, standardisation of hospital charges is necessary for providing affordable treatment so that healthcare is not only effective, but also sustainable in the long run for those who finance it. We and the other PSU insurers (through General Insurance Public Sector Association’s Preferred Provider Network) have managed to achieve a certain level of standardisation with our network hospitals. And yes, we certainly expect a broadly consensual and fair standardisation of charges and packages across the entire spectrum of hospitals, pan-India.
Can we expect any co-ordinated effort from the IRDAI, central and state governments, insurers and hospitals to resolve the disputes?
There have been discussions between IRDAI, the General Insurance Council, insurers and the central government. This coordination is expected to continue. Specific disputes will mostly be dealt with by the insurance companies themselves. The insurance regulator has made it clear that policyholders’ welfare is a matter which they consider paramount.
Has COVID-19 underscored the need for a hospital regulator? Would such a regulatory body have helped iron out issues faster in the current situation?
Yes. A regulator can definitely help in ensuring an optimum balance of affordability, sustainability, prevention of sharp practices and protection of patients’ rights.
The pandemic has also resulted in patients postponing elective surgeries and other treatment procedures. How has this affected overall claims received?
We have seen around 30 per cent reduction in the number of claims during these three months, but this respite is temporary. What we call an elective surgery is rarely an absolute matter of choice, except perhaps for the choice of when to do it. We have had quite a number of non-COVID claims also during these three months. However, we still do not have a clear picture as to how the claims profile will develop in the months to come.
Have you seen sharp rise in demand for health insurance policies now? Are you seeing a demand for larger health covers and top-ups?
There is a discernible rise in the number of retail health policy buyers, but not enough. Some of the corporate buyers have started asking for higher cover limits or top-ups for their employees. However, I want to stress that the prevalence of health insurance is still nowhere near acceptable levels in India. This is a matter that should worry all of us.
What will be the long-term impact of COVID-19 in the way insurers operate?
General insurance is one of the true barometers of the economy’s overall health. Insurers are now looking at a market characterised by severely-truncated budgets of all their corporate clients and less cash in the pockets of their retail clients, both of which impact the insurance-buying capacity. We have had to digitalise very quickly to continue transacting in today’s market and entire workflows have had to be redesigned. Even after the lockdown is lifted across the country, social and business interactions will entail avoiding physical proximity. This calls for entirely new business practices that insurers will have to design, learn and implement. Insurance products will have to be reviewed to include the widespread demand for pandemic covers. One thing is certain – we will never be able to go back to the world as it was before March 2020.