Challenges and Solutions in Health Insurance Claims and Policyholder Experience in India

Health insurance claim processes in India face challenges including complex top-up policy procedures, hospital documentation errors, and rising premiums. Policyholders often encounter delays and rejections due to deductibles, incorrect medical records, and coordination issues among insurers, hospitals, and third-party administrators. Industry experts suggest the need for a dedicated health regulator, improved product customization, and leveraging AI to enhance transparency and reduce customer dissatisfaction amid increasing costs.