Our Virtual Care Managers Make Claims Processing Smooth
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Our Virtual Care Managers Make Claims Processing Smooth

As the country gears up for Ayushman Bharat, a national health protection mission, healthcare and health insurance are expected to witness a paradigm shift. In a candid conversation, Mayank Bathwal, Chief Executive Officer of Aditya Birla Health Insurance Company, tells Naveen Kumar how this much-awaited healthcare programme may impact the industry, the role of digitisation and the unique initiative the insurer has taken to make claims processing hassle free. Edited excerpts:

Our Virtual Care Managers Make Claims Processing Smooth

You offer a special category product called Critical Illness and Cancer Secure. Wouldn't it be better for customers to buy one compressive plan that offers a broader coverage for all health conditions?

Mayank Bathwal: The cost of medical care is high for critical illnesses like cancer, and a comprehensive cover would result in high premiums, which may not match people's insurance budget. Hence, the critical illness cover is kept separate to mitigate such risks besides comprehensive plans. These special plans provide lump sum amounts right from the time of disease detection. It not only supports the cost of treatment but also ensures income protection when the insured can no longer earn due to health issues.

With the rising cost of healthcare, what options do people have to increase the sum assured? Do you offer a top-up option?

Our health insurance plans come with features such as a no-claims bonus, which would help customers deal with inflation to some extent. But for the long term, it is always advisable to apply for an increased sum insured. If the insurer approves it, you will get increased coverage under the same policy. Otherwise, a customer may opt for an aggregate top-up plan, which will provide an extra cover over and above the existing policy. Aditya Birla Health Insurance gives you the option to increase the sum insured across all its products. Plus, we have a best-in-class top-up cover for our Activ Health policy.

What about Ayushman Bharat? Will the government-backed initiative impact the industry and bring down healthcare cost?

It is too early to comment as the initiative is yet to make a full-fledged debut. But I think it will have a positive impact on healthcare and health insurance. For one, the increased demand for healthcare will be fully funded, which will enable the healthcare industry to increase supply and improve quality. Of course, there is initial feedback from hospitals that says the proposed rates under the scheme are too low, but that will soon get resolved. Overall, it will bring down healthcare costs. For health insurers, it will open up the opportunity to work with the government and boost awareness in rural areas. It will have a cascade effect on the masses who will realise the need for health insurance cover.

Given the growing digitisation, how is your company doing? What percentage of your total sales, both direct and indirect, is coming from the digital channel?

In India, the insurance sector was once considered a laggard when it came to technology adoption. But we are now shedding that image by adopting disruptive technologies across operations. Over the past few years, the industry has made considerable investments in digital and IT tools such as mobile apps, Big Data, analytics and chatbots to address a gamut of business challenges, including customer acquisition, engagement, detection of fraudulent claims, designing personalised policies, improving insurance persistency and so on.

Our company has in place an end-to-end digital ecosystem that uses these technologies to bring in efficiency and a better experience for customers. More than 10 per cent of our total sales come from the digital channel, and 85 per cent of our total policy issuance is digitally enabled.

What are you doing to improve claims experience?

In the health insurance space, at times, customer experience might not be as good as you would like it to be. When people filed hospitalisation claims, be it pre-authorisation, extended hospital stay or painful discharge, there had been inadequate support from insurers. So, Aditya Birla Health Insurance has adopted a customer-centric approach from its inception and mapped various pain points which a customer faces. We understand that the people involved in helping our customers must have relevant experience and expertise. Therefore, we have introduced Virtual Care Managers who are medically qualified professionals and not just call centre executives. As soon as claim intimations reach us, our Virtual Care Managers get in touch with the policyholders and their families to provide end-to-end assistance - right from admission to discharge to claim settlement. It is a unique, first-of-its-kind initiative, and our team of experienced specialists also guide our customers during extended hospital stays.

What's the response to health plan portability? Will it ever be on a par with the telecom industry?

Portability guidelines were introduced by the IRDAI to protect the interest of the insured when they transfer their existing policies to new insurers. And the industry has welcomed the framework. In our experience, customers do not port their plans just because claims have not been settled to their satisfaction. There are other reasons such as service issues or better offerings. Also, given the spirit of regulatory guidelines, insurers do not underwrite lives differentially. Whether they are coming as porting requests or fresh proposals, assessments are done as per the objective criteria of the policies. We don't see porting as stalling; it is a good option for consumers and contributes significantly to an insurer's top line. But considering the current size of the health insurance segment and its pan-India reach, it is too early to compare the scenario with the portability level in the telecom industry.

@naveenkumar80