The recent observations has brought that the average cashless claim disbursal is nearly double that of reimbursement claim payouts in case of several ailments.
For instance, the average claim payout during 2013-14 for diseases of the circulatory system (including cardiac ailments) was Rs 81,384 through the cashless facility, but it was just Rs 38,048 under the reimbursement mode. Similarly, for diseases involving blood and blood-forming organs and immune disorders, the average claim paid out through the cashless mode was Rs 35,958 while that through the reimbursement route was just Rs 17,726. Activists believe that reimbursement claims get partially settled as individual policyholders do not have the bargaining power at that stage, while hospitals can get claims fully settled due to their relationship with insurers.
The disclosure on reimbursement and cashless claims is an outcome of the ongoing court proceedings concerning the case where it was found that out of the 22 diseases, reimbursement amount is lower in all cases except mental disorder. Insurers, however, insist that this does not qualify as an apple-to-apple comparison.
