A seamless insurance buying experience is a great comfort. According to current data, many health insurance claims experienced unsatisfactory settlements in 2023-24. Buying an insurance policy has become a simple and quick process for most people today. Digital forms, online payments, and instant coverage options allow you to purchase a policy in minutes. On the other hand, when you need to file a claim, the process can be complex, paperwork-intensive, and sometimes even frustrating.
Why are Insurance Policies easy to purchase, but so Difficult to understand while claiming
In this article, you will understand why this happens, what factors make claims difficult, and what you can do to ensure your claim is successful.
Why the Buying Experience Is Easier
Digital Platforms and Marketing
Digital technology has simplified the buying process significantly. The entire experience of searching, comparing, and purchasing policies is available on websites and mobile apps. Acquiring new customers is a priority for companies. Advertising and easy premium options attract customers quickly.
Agent Avaialblity
Almost all insurance companies hire agents to find people to whom they can sell insurance policies. These agents often pressure customers to buy insurance and appear helpful during the buying process. They are available to customers at every step while selling, but many of them mislead by hiding the drawbacks of a policy and keeping customers in the dark just to earn their commission and meet sales targets. Their main aim becomes selling the policy, not safeguarding the customer’s benefits.
Less-Fuss Forms and Quick Payments
Filling out forms takes less time, and payments are processed instantly through payment gateways. This makes buying psychologically easier. Selling agents and brokers recommend plans and often activate coverage immediately.
Why Claims Are Difficult
Financial Risk and Investigation Pressure
Approving claims can be a financial burden for the insurance company. Paying large claims can impact the company’s financial position. Therefore, the company’s system thoroughly investigates claims. This thorough investigation involves reviewing documents, hospital bills, medical history, and sometimes medical audits. This makes the process lengthy and complex.
Lack of Documents and Incorrect Information
Many claims are denied due to a lack of documentation, incorrect details, or the omission of pre-existing conditions. Information provided at policy purchase is verified, and if concealment is found, the claim can be rejected. These rules may seem strict to customers, but companies implement them to control risk.
Waiting Periods and Exclusions
Many health policies have waiting periods and exclusions for specific treatments. These conditions apply pre-purchase at the time of policy purchase. In other words, coverage for certain illnesses and treatments is not immediately available. If this condition applies at the time of filing a claim, the company may reject it.
The Need to Prevent Fraud
Fraud is a real problem in the insurance industry. Companies implement rigorous verification to prevent illegitimate claims. Sometimes, this verification also causes problems for honest claimants. Technology-based verification and audits can lengthen the process.
Impact of Network and Procedure
It is easier to get direct reimbursement or cashless treatment at a network hospital. Treatment at a non-network hospital can be more cumbersome, with more complex paperwork. Furthermore, people have to collect all the evidence and procedures, such as claim reporting deadlines and police reports, which also impact the claim process. In many instances, court decisions have been made despite a delayed FIR or delayed notification, but the process is quite stressful.
For example, a family purchased a low-cost policy online, but the policy did not disclose certain pre-existing conditions. This became apparent during the claim process during hospitalization. The company rejected the claim, causing the family considerable mental and financial distress. The simplest way to avoid such situations is to provide the full truth before the price is quoted and to have documentary evidence.
What You Can Do – Practical Tips
Read and Understand Before Purchasing a Policy
It’s your responsibility to carefully review the policy terms, waiting period, exclusions, and claim process. Ignoring the paperwork can lead to complications later.
Keep Records and Report Timely
Preserve all receipts, reports, and doctors’ notes related to your treatment. Report the claim as soon as possible. Timely reporting reduces the chance of the company making excuses.
Understand the Premium Deal
Lower premiums often mean less coverage or a longer waiting period. Make a balanced choice based on your risk profile.
Take advantage of network hospitals
Choosing a network hospital in an emergency can provide immediate relief through cashless services. This reduces your correspondence and simplifies claims.
Your Rights and Consumer Protection
The regulatory body IRDAI formulates policies in your interest. A complaint can be filed for any unplanned denial. In many cases, courts and consumer forums have ruled in favor of consumers. If you feel unjustified by the denial of your claim, seek assistance directly from the regulator or consumer forum.
