July 29, 2021

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Average ticket size of health claims for Covid patients up 20-50% in second wave of the pandemic

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REUTERS/Chalinee Thirasupa

CHENNAI: Even as the period of hospitalization halved in the second wave of the pandemic, the average ticket size of health claims for Covid patients increased from 20 to 50%, as compared to the peak of the first wave in 2020.

Director of underwriting, products and claims at Max Bupa Health Insurance, Bhabatosh Mishra says that we saw the average ticket size of claims go up from Rs 1.3 lakh to Rs 1.5 lakh. “The period of hospitalization has declined from an average of 14 days to 7-8 days in the last few months,” he said.

“Surge in the bill size of Covid-19 treatment is largely due to hospitals charging separately for oxygen cylinders and equipment used in the ICU. Don’t understand why they should charge for the ICU equipment separately? The use of high-priced drugs has further led to a high cost, and therefore a higher claim size,” Mishra told TOI.

Usually, hospitals and insurance companies agree on the hospitals tariff as part of an agreement that can last for 3 years, which is inclusive of ICU room cost.

A member of the General Insurance Council, which is a representative body of insurance companies formed by Insurance Act 1938, said that there is an average increase of 20-25% in the average ticket size of Covid health claims settled. “This is driven by the number of cases which had co-morbidities and required additional medical treatment – which includes costlier medicines.”

For example, in the second Covid wave, the claim amount could continue to remain at Rs 1 lakh, similar to the first wave. However, the number of days of hospitalization would have reduced from 18 days to 9 days. In such cases, the bill amount remains unchanged in both the periods, however, the per day hospital charges can go up.

ACKO (Acko General Insurance) observed the average ticket size of such claims has increased over 50%, with over 100% sharp rise in Covid-19 claims in the second wave than the first wave.

Its SVP(Senior Vice President) and head of claims Suman Pal said “Most critical patients were hospitalized, who needed more aggressive medical intervention and extended periods of hospitalization, during the second wave. The average length of stay during Covid-19 second wave claim ranged between 8 to 15 days. The average ticket size settled so far is about Rs 1.48 lakh for ACKO for such claims, but in some cases the claim size has gone up substantially.”

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