To resolve claims faster, private general insurance companies, including ICICI Lombard, Bajaj Allianz, Star Health and HDFC ERGO, have set up in-house claims management network, instead of hiring third-party administrators (TPAs).
Even though a small portion of their business is still handled by external TPAs, insurers said they were getting closer to achieving 100% processing of claims internally.
When it comes to rejected claims or pending claims, TPAs rejected as many as 4.9 lakh health claims, amounting to 1,851 crore in hospital bills, compared with 3.7 lakh claims getting rejected by in-house insurers, amounting to 1,472 crore. India has 30 TPAs registered with IRDA. Pending claims are also more than double at TPAs. For 2015, 4.4 lakh claims remained pending at the end of period amounting to 3,757 crore in hospital bills, compared to 2.1 lakh claims amounting to 962 crore in-house.
