Paying Claims Quickly with Least Denials

Antony Jacob
CEO, Apollo Munich Health Insurance

What is the state of health insurance business from the Apollo Munich perspective?
Over the last decade and a half, India is on a fast-track to get integrated with the rest of the world through economic and cultural inclusion. Technological advancements in communications have led to never-ending work-days. People are always connected to their offices, even on their breaks. This continuous pace of life has led to increased instances of lifestyle related ailments such as higher blood pressure levels, sugar levels, obesity, cardiac concerns, etc. And medical technological advancements have resulted in an ever increasing healthcare cost, making healthcare unaffordable for many. Health insurance is the best possible solution to combat the effect of this double whammy. Bancassurance will prove to be a very effective channel for health insurance distribution as it allows insurance companies to tie up with banks across locations to sell their products to bank customers through better engagement and communications. It will ensure a wider reach and help a long way in increasing awareness rapidly.

How important is it to tie up with hospitals and healthcare companies and how Apollo Munich is doing that?
With our parentage that includes Apollo Hospitals, a leading healthcare provider in the country, we believe it is indispensable for a health insurer to have tie ups with hospitals. Positive and long term partnerships with healthcare providers help to ensure that customers receive the best care when and wherever it is required. Today, we have tie-ups with over 4,000 hospitals and other healthcare providers. We have a team of doctors on our staff who works very closely with the medical community to ensure that the right services are rendered to our customers, at the right price. Our customers benefit as they can avail the best treatment at best  acilities on cashless basis, while paying an affordable premium rate.

What are the challenges in health insurance claims management, and how do you overcome them?
We have a robust claims process management system in place that takes care of the entire claims procedure, from the time a claim is sent in to usto verification and disbursal.From e-cards to ensuring approval for cashless treatment within 65 minutes to the fastest claims payment time among stand-alone health insurers, we go to great lengths to ensurecustomer satisfaction in this important area. 98 percent of the claims are paid by 15 days. The largest challenge we face in our claims management process is ensuring that we pay claims to our customers quickly and with the least amount of denials. Due to several reasons such as hiding facts, illegible writing on proposal forms, exclusion of certain procedures, claims are often delayed or denied. We ensure that each of our customers has a thorough understanding of the inclusions, exclusions, waiting periods and procedures at the time of signing on with us to ensure that no hiccups occur during claims.

How do you perceive the importance of ICT in the health insurance claims management?
ICT perhaps plays the most critical role in automating the fulfilment processes in customer facing businesses such as insurance. However, the pace of ICT utilisation has been slow when it comes to the claims processes. This may be due to the fact that the processes related to claims require integration of multiple stakeholders including healthcare providers. We believe ICT should play a significant role in enabling real time data sharing requirements between the claims facilitators and providers. This may be possible by creating a data highway where each customer, provider and claims facilitator can work in tandem for faster decision making through real time sharing of information.We have recently transformed its core IT infrastructure and this has led to increased operational efficiencies aswell as business up-time.

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