Mastering Health Insurance: How To Navigate 100 Percent Bill Payment?

The pandemic has re-emphasised the importance of healthcare and individuals have started paying more attention toward understanding the various aspects of health insurance. While thinking about buying the policy, the obvious focus usually lies on the coverage benefits and related features. What one, however, misses out is – what expenses will get paid and what will be excluded at the time of claim.

There are many non-medical expenses associated with hospitalisation that are generally not covered by health insurance policies in India.

Non-payable expenses in Health Insurance policies

Some of the most common non-payable expenses that are not covered by traditional health insurance products in India include consumable items such as syringes, gloves, dressings, and bandages or even critical items like oxygen masks.

Moreover, some hospitals may charge the patients administrative fees like medical records or registration that are not covered by traditional health insurance policies. Then there are attendant charges where the cost of hiring one may not be covered in the health insurance policy.

There are around 68 items which may seem inexpensive but can make up a hefty amount in the overall hospital bill. Such items generally form 5 to 15% of the bill amount & in certain cases, especially during rise in covid cases, went up to 20 to 25% of the bill amount.

What does 100 percent bill payment mean in health insurance?

The term “100 percent bill payment” means that the insurance company will pay the entire hospital bill incurred by the policyholder, subject to the sum insured, with no out-of-pocket expenses from the policyholder on the medical expenses.

What can insurers do to ensure 100% bill payment in the healthcare ecosystem?

There are a lot of variances in the healthcare industry around protocols for consumable utilisation.

Insurance companies and hospitals need to come together and agree on standard protocols at a procedure level for utilisation of such items.

While some insurers may be willing to cover such items by factoring in the pricing if there is predictability of such expenses. Some have taken steps, especially post covid, to cover for some consumable items by making a list specific to the respective company. This is a good start to deliver a better experience to customers for deductions at the time of claims, which is the critical test of time for the health insurance policy.

Additionally, it ensures peace of mind for the customers who will not need to worry about the separate headers on what is covered and what is not.

In conclusion, 100 percent bill payment is a valuable benefit that comes with cashless health insurance policies. It ensures that the policyholder need not worry about paying any hospitalisation expenses from their pocket.

However, it is essential to read the policy documents carefully and understand the terms and conditions before purchasing a health insurance policy. It will help you make an informed decision and choose a policy that suits your healthcare needs.

With the continuous aim to support customers in their end-to-end healthcare journey, insurance companies should collectively take the approach on how best to cover for ~100% of the bills by defining reasonable spends for a procedure or hospitalisation.

-The author is VP – Retail Health, ACKO. Views expressed are personal.

Disclaimer:The views expressed in this article are those of the author and do not represent the stand of this publication.

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