Does your health insurance company pay its claims?

Let's Talk Money with Monika Halan

In this episode, Monika explores the troubling issue of health insurance companies denying claims, a problem that has taken center stage globally and in India. A shocking incident in the U.S. on December 4, 2024, saw Brian Thompson, CEO of UnitedHealthcare, America’s largest health insurer, shot dead as he walked to an investor conference. Reports suggest the attack may be linked to mounting public frustration over insurers' tactics to “deny, delay, and depose” claims to boost profits, with UnitedHealthcare rejecting 32% of claims.

Shifting focus to India, Monika highlights worrying trends documented by the Insurance Brokers Association of India. Public sector insurers perform far better than private firms, with New India Assurance paying 98.74% of claim amounts, while Star Health lags behind at just 54.61%. Disparities in claim metrics—by number of policies versus amounts—indicate some insurers may settle low-value claims quickly while dragging their feet on higher payouts. Loopholes in fine print and a lack of transparency add to policyholders' struggles.

The conversation emphasizes the challenges of a three-party system involving insurers, hospitals, and policyholders. Unregulated hospitals often inflate bills or unfairly charge patients, further complicating matters. Monika stresses the urgent need for IRDAI to improve transparency, mandate better disclosure, and ensure smooth portability for customers switching insurers. Until then, buyers must remain vigilant: analyze claims data, compare insurers, and port policies with poor claims records before renewal.

Listener queries focus on practical financial challenges. Abhishek asks about the difference between holding mutual fund units in a demat account versus a statement of account, seeking clarity on costs, flexibility, and their respective pros and cons. Nakaashi from Mumbai raises concerns about his retired parents' financial portfolio, exploring how to balance medical expenses, inflation-proof investments, and their desire to leave an inheritance. Purva from Pune wants to know how to plan portfolio exits during market corrections, focusing on asset allocation and strategies for rebalancing investments effectively.

Chapters:

(00:33 - 8:00) The truth about health insurance claims and what you can do about it

(8:04 - 11:46) Understanding the demat account vs statement of account for mutual fund holdings

(11:48 - 14:48) How to manage your retirement portfolio for long-term financial health

(14:51 - 16:29) Timing your exit strategy for retirement investments

https://www.ibai.org/storage/media/news_letter/general_insurance_claim_insights_2024_04122024-180441.pdf (see pages 83 and 84)

https://www.livemint.com/Money/9i0qJW6mkQ9e9W7v8FUswN/History-of-mutual-funds-in-India-as-told-by-the-first-inves.html

If you have financial questions that you’d like answers for, please email us at ⁠[e-mail]⁠

Monika’s book on basic money management

⁠⁠⁠⁠⁠⁠⁠https://www.monikahalan.com/lets-talk-money-english/⁠⁠⁠⁠⁠⁠⁠

Monika’s book on mutual funds

⁠⁠⁠⁠⁠⁠https://www.monikahalan.com/lets-talk-mutual-funds/⁠⁠⁠⁠⁠⁠

Monika’s workbook on recording your financial life

⁠⁠⁠⁠⁠⁠⁠https://www.monikahalan.com/lets-talk-legacy/⁠⁠⁠⁠⁠⁠⁠

Calculators

⁠⁠⁠⁠⁠⁠⁠https://investor.sebi.gov.in/calculators/index.html⁠⁠⁠⁠⁠⁠⁠

You can find Monika on her social media @monikahalan.

Twitter ⁠⁠⁠⁠⁠⁠⁠@MonikaHalan⁠⁠⁠⁠⁠⁠⁠

Instagram ⁠⁠⁠⁠⁠⁠⁠@MonikaHalan⁠⁠⁠⁠⁠⁠⁠

Facebook ⁠⁠⁠⁠⁠⁠⁠@MonikaHalan⁠⁠⁠⁠⁠⁠⁠

LinkedIn ⁠⁠⁠⁠⁠⁠@MonikaHalan⁠⁠⁠⁠⁠⁠

Production House: ⁠⁠⁠⁠⁠⁠www.inoutcreatives.com⁠⁠⁠⁠⁠⁠

Production Assistant:⁠⁠⁠⁠⁠⁠ Anshika Gogoi⁠⁠⁠