Claim Settlement in 30 Mins: Why Speed Defines the Best Health Insurance Company in India?
During medical emergencies, speed defines the scope of treatment. It includes many aspects like the speed of medical attention, the availability of medicines, payments, etc. In FY 2024-2025, insurers have approved about 3 crore health insurance policies worth ₹94,248 (approximately). As the healthcare inflation is at around 12 - 15%, and more people purchase health insurance to cope with this rise, rapid claim settlement is becoming a primary factor for choosing a reliable insurer.
In this context, this blog explains the significance of speed in medical claims processing to the best health insurance company in India and what mechanisms help deliver faster claims.
An Overview of Claim Settlement
The Claim Settlement is the process in which the insurer reviews, verifies and approves payment for expenses covered in an insurance policy. In terms of medical health insurance, there are two forms of claims settlement options that are widely followed. Here they are as follows:
● Cashless Claims: In this claim procedure, the insurer directly pays the medical bills minus your deductibles to the network hospital.
● Reimbursement Claims: On reimbursement claims, first you make the payment to the network hospital, and then the insurer reimburses the medical bill minus your deductible through your preferred payment method.
The Concept of 30 Minute Claim Settlement
The main idea of the 30 minute claim settlement is connected with India’s digital transformation. Before the widespread use of the internet and digital systems, medical claims took multiple hours and or sometimes a few day because of the following reasons:
● Multiple layers of manual verification
● Checking of documents physically
● Back-and-forth communication between hospitals and insurers
Today, advanced systems enable real-time data verification, automated eligibility checks and digital document uploads. Along with that, pre-authorisation workflows allow the best health insurance company in India for family and individuals to assess coverage prior to hospitalisation or beginning the treatment. As a result, claims can be processed much faster.
For example, insurers like HDFC ERGO provide cashless health claim approvals on average within 36 minutes. Yet, the actual time is subject to the submission of the required documents.
Influential Factors of Faster Claim Settlements
There are three primary factors that accelerate medical claim settlement, which are as follows:
1. Rise of Digital Platforms
Modern health insurance is increasingly delivered over digital ecosystems. The whole network of computers, mobile phones and servicers allows the insurer to manage claims in an efficient manner. Under the National Health Claims Exchange (NHCX) initiative, health insurance claim information is exchanged through one common digital gateway. This system allows hospitals and insurance companies to exchange policyholders’ medical conditions and basic information in a seamless manner.
2. Automated Claim Submission and Verification
In many systems, hospitals use the policyholder’s insurance ID to submit claims through the NHCX portal. It allows instant digital verification of identity and policy coverage. It allows insurers to seamlessly conduct the eligibility checks and settlement decisions with fewer steps.
3. Application of Standardised Process
As the insurers and hospitals operate on the same data formats and validation systems, the whole claim is approved without having any major issues. Here’s how the digital health insurance claims work:
1. Pre-authorisation requests are transmitted to the insurer over digital networks and reviewed with automated checks.
2. Discharge approval decision follows a predefined timeline that helps hospitals to finalise bills in a faster way.
3. Upon the successful match with the claim reason, the medical insurance claim gets approved for the particular policyholder.
How to Prepare for a Smoother and Faster Claim Experience?
You can follow the five steps below to facilitate the claim settlement process:
● Keep your health information and policy data updated to your insurer’s platform.
● Save digital copies of your identity proof, policy documents and medical records.
● Use the official channels of your insurer for uploading documents or sending the request for claims.
● Maintain a checklist of commonly required documents, such as discharge summaries and medical bills.
Final Thoughts
The 30 minute claims approval for medical insurance has gained popularity mainly due to rapid digitisation across India. The best health insurance company in India usually follow a structured process that adheres to the National Health Claims Exchange initiatives. It helps both the insurer and hospital to seamlessly exchange information about the policyholder’s medical conditions and the expenses related to medical treatment.
(The views, opinions, and claims in this article are solely those of the author’s and do not represent the editorial stance of The Assam Tribune)