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Things could change for people juggling between hospitals and health insurance companies

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A blend of technology and human understanding is essential for insurance companies to stay relevant and competent states Ritesh Kajaria, Founder and CEO, Healthnine Technologies

The emotional-economic pitch for people while buying a health insurance is the sense of assurance- a promise that in case of any medical emergency, there is adequate financial cover for them and their family to support the hospital expenses. However, many a times, this assurance meets with reality when they must run around hospitals and insurance company’s representatives, with heaps of documents. This dampens the overall customer experience and brings down trust upon the concept of health insurance.

The claims settlement process is one of the most important aspects of an insurance policy, especially if it is a health cover. The rising number of options for health insurance and the advent of technology has influenced the behaviour and expectations of customers. Therefore, it is imperative that the industry also evolves and offers products and processes centred around customer experience. Here is how technology can transform the claim settlement process for health insurance providers: –

Cutting down the paperwork- Policyholders lose several days by the time hospitals and insurance companies complete the paperwork. This is because the existing systems of hospitals and insurance providers cannot communicate with each other. As a result, every entry should be replicated in a different format, wasting time and effort. By using a common, connected health information network for collecting the basic information about patient (policy details, diagnosis, discharge reports etc.), both the entities can eliminate the need for dual entries. This cuts down the resource requirements for documentation. At the same time, the processing cost per claim also goes down.

Automation of iterative processes- Data entry, validation and revision are some repetitive manual process. This not only consumes time but also increases the chances of errors. An integrated insurance claim management platform makes it possible to automate this process to a great extent. Important data points such as itemised bills can be automatically fetched from hospital CRM and fed into the claim management portal, without any human intervention. Moreover, the system can also allow pre claim edits at the hospital level. So, the chances for incomplete pre-authorisation/claim request are minimal.

Real time monitoring and evaluation- Once multiple stages of documentation are completed, it is important to have real time updates on the claim settlement ratios, general roadblocks and any major trends which bring down the turnaround time below an accepted benchmark. A live claim dashboard addresses this requirement and allows the insurance provider to establish a differentiator in terms of turnaround time for claim settlement.

Fraud detection and prevention- A deep dive into the mammoth pool of claim forms can fetch unique insights about fraud patterns. Therefore, a health information network powered by data analytics engine and artificial intelligence can be extremely valuable in terms of eliminating insurance claim fraud at an early stage. As the number of unscrupulous claims go down, there will be faster turnaround for genuine claims.

Information security and compliance- Medical records contain very sensitive personal and societal information. Based on the highest data safety standards, the system can ensure data integrity and safety all the time. This means that the hospital as well as insurance service provider can focus on the core job, i.e., speed and accuracy in terms of claim settlement.

The above list is not exhaustive but only indicative. Like many other services, health insurance is a long-term relationship between the subscribers and the company. Therefore, user experience is extremely critical in order to maintain this relationship. The key to success is to create a fast, convenient, and safe customer experience at the time of claim settlement. Therefore, a blend of technology and human understanding is essential for insurance companies to stay relevant and competent.

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