While health insurance is a solid saviour during financial crisis that may arise due to medical emergencies, insurance frauds remain a major cause of worry for customers.
Insurance scams came by both ways, that is, via the insured or the insurer. If either party produces fraud, false or misleading information with an intention to gain unfair benefit from a policy, it’s an insurance fraud.
Such frauds often result in serious losses for the insurance company. As a precautionary measure, insurers may be forced to shrink the potential advantages of a regular health insurance policy for genuine customers.
Filing an insurance claim for treatments that wasn’t actually administered to the insured or increasing overall cost of hospitalisation by including services that were not part of the medical problem are few common types of frauds identified in India.
Another type of health insurance fraud is the non-disclosure of pre-existing diseases, producing fake diagnosis reports to justify tests and surgeries in order to file claim.
A major cause of worry linked to the fallout of any insurance fraud is it’s impact on other customers. Increase in incidences of frauds could simply lead to the elevated cost of services.
If such frauds are identified by the third party administrator or the primary insurer at any level of document verification, your claim will be immediately rejected. Your policy could, in fact, stand null and void.
Insurance frauds also lead to a stricter scrutiny of claims. This would make the process longer and eventually delay settlements. Hence, rise in insurance frauds have a holistic impact within the industry as well as on customers.
The ongoing pandemic saw a massive rise in health insurance claims. This increased the pressure on insurance companies to verify and reimburse the money on time. Many cases of fraudulent claims rose during this time.
However, advanced technology has made it easier for insurers to carry out the claim scrutiny in a seamless manner. Customers must cooperate and keep the documents supporting their claim handy for quick settlement.
