KOLKATA: Shorter hospital stays, a per-day limit on consultation and PPE charges and cheaper treatment at satellite facilities run by hotels and hospitals have led to a 40% drop in the average ticket size of a Covid-related insurance claim in July, compared with May and June, even as the total number of insurance claims has shot up, with the rise of cases in Bengal.
Jyotirmay Kundu of Heritage TPA, one of the state’s leading third-party insurers, said they have been getting, on an average, 40-50 Covid insurance claims per day in July and August, up from 20-25 in June. The total cases for PSU insurers (National Insurance, New India, United India and Oriental Insurance taken together) would be 100-120 per day in July-August, compared to the 40-50 they had been getting in June, according to their representatives. PSU insurers account for more than 70% of the health insurance market of the country.
“The number of claims has gone up by over 50% to 60% in July-August, but the silver lining is that the average billing size is coming down,” Kundu told TOI. C Bera of Raksha TPA agreed: “The average billing size is coming down, except for a few hospitals.” Kundu explained that one of the main reasons for this was that the duration of hospital stay had gone down from around 13-14 days to about seven to 10 days in the last one month.
The limit of Rs 1,000 per day on consultation and PPE charges — although some hospitals were flouting this norm — was another reason, they felt. And finally, a lot of not-very-serious patients were opting for satellite facilities opened by hospitals and hotels, where the treatment cost is less, felt Kundu. “These bills are 25%-30% smaller compared with full treatment in hospitals,” he said. Bera felt the government-introduced protocol of restricting high-end antibiotics could be another reason for smaller bills and claims.
B Nerurkar, head of health claims at Bajaj Allianz General Insurance, said the fall in the average claim size was a national trend. “We have so far received 3,000 claims nationally, and the majority was in July,” he added.
According to B Nerurkar, head of health claims, Bajaj Allianz General Insurance, along with conventional policies, they have started settling claims for Corona Kavach (standard health insurance policy for individuals and families which provides coverage of up to Rs 5 lakh for hospitalization expenses related to Covid-19) as well, which was introduced in July by all non-life insurers.
Sanjay Datta, chief, underwriting and claims, of ICICI Lombard, pointed out the inherent cost of treatment is coming down. “Now, PPE and ventilators are being manufactured in India. Covid is spreading to small towns, where cost of treatment would be less,” he added.
Explaining the sudden rise in overall insurance claims in July compared with June, claim coordinators in hospitals said admissions nosedived in March, April and May as people stayed away from hospitals out of fear. “At the time, Covid beds were limited in most hospitals and non-Covid patients were not coming for fear of infection. In mid-June, the situation got streamlined with Covid beds going up and non-Covid patients gaining confidence after learning about the protocols that had been established. Also, surgeries that had been delayed became urgent. In July, we went back to the pre-Covid period occupancy, which was roughly twice the patient count of June’s,” said an executive.
Source: The Times of India
10-08-2020
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