Despite the government’s decision that the insurance company should bear the medical expenses of the Kovid-19 infected, the insured will not get this facility immediately. This is because the insurance companies do not pay the claims on time.
Infected people will initially have to seek treatment at their own expense. Only then will the research be paid by the company, said Rajuraman Poudel, executive director of the Insurance Committee. “Initially, the insured has to pay for the treatment at his own expense,” he said. “After submitting all the documents, the insurance company pays the claim.” Following this decision, hospitals have started charging patients for treatment. Insurers are in trouble as they cannot get immediate payment of claims from the insurance company.
‘The government says to treat yourself,’ said one infected person, ‘when is it time for the insurance company to pay, how to cover the cost of treatment at such a time?’ “The insurance is designed to ease the inconvenience,” he said, adding, “What’s the point of not getting the payment when you need it?” Former finance secretary Rameshwar Khanal said that the hospital should deduct the expenses from the insurance policy of the insured as per the criteria of health insurance and if the expenses exceed the insurance amount, only the person should take it from himself. He says insurance companies should work according to this principle. He said that the insurance committee should be responsible if the insurance company does not pay on time. “The committee has the power to revoke the license of a company that fails to pay the claim within the stipulated time,” he said. The directive is to go into action to implement it effectively. ‘
According to the government’s decision, the Ministry of Health and Population will provide free testing and treatment only if there are symptoms of financially deprived, disabled and helpless citizens, single women, severely disabled, senior citizens, frontline health workers, sanitation workers, security personnel and others. Jageshwar Gautam had stated. According to the ministry, those who have corona insurance will have their medical expenses deducted from the sum insured, but there will be difficulties in treating the infected in the coming days as there is no immediate payment from the insurance company.
Although corona insurance claims are paid based on PCR test reports done in private laboratories, the insured has not yet received that facility. The Insurance Committee had made such an arrangement by amending the ‘Corona Insurance Standard 2077’ on 28 September. Even after more than a month of the revision of the criteria, the insured who have tested in a private laboratory have not been able to get the claim paid. The insurance company claims that the claim has been paid by showing all the test reports done in the government hospital.
The insurance companies had said two weeks ago that there would be some delay in paying the claims to the insured who met the criteria as soon as possible, but the claims of the private laboratory have not been paid till Monday. The insurance company has stated that the claim could not be paid on the basis of the PCR report done in the private laboratory as the verification work has not started yet.
So far, only 1,200 out of 11,000 claims have been paid. This is about 13 percent. According to the BIMAC, 87 percent of the claims have not been paid till Sunday. As of Sunday, more claims have been paid than the premium raised from the sale of insurance policies. According to the Corona Insurance Standards 2077, the insured should have received the required documents within seven days at most, but the insurance companies have been reluctant to pay on various pretexts.
“The committee allowed the insurance policy to be issued without adequate study despite the provocation of the insurers. Now it has become a bottleneck,” the official said. The official claimed that the committee and the insurers’ association are now planning to avoid the interests of the insured. There are many inconsistencies in the new criteria. He said that some provisions were against the provisions announced by the government.
In recent weeks insurance companies have begun to refuse to insure Corona. The company has stopped insuring due to increasing claim payments. The companies have said that the customers have not shown much interest in the insurance plan brought after September 12. According to the new arrangement, if the corona is confirmed and stays at home in isolation, a lump sum of Rs 25,000 and a maximum of Rs 75,000 for medical treatment after treatment at the hospital. Before September 12, the insured will get a lump sum of Rs 50,000 and Rs 100,000.