How can AI-Powered Diagnostics Redefine Health Insurance Claims?

• Written by Mudit Handa

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Just like all aspects of our lives, Artificial Intelligence (AI) is revolutionising health insurance, transforming how diagnostics are conducted and policies are structured. To understand how, meet Sandhya, a 27-year-old insurance policyholder who is dealing with a serious health issue. She schedules several tests, but it takes over two weeks to get results and feedback from healthcare professionals, which is stressful and frustrating. 

With AI in healthcare, Sandhya's experience would be much easier. 

How?

AI can quickly analyse her test results with great accuracy, speeding up the entire process. This means she would receive faster treatment, and her health insurance claim could be approved more quickly and accurately, making her healthcare journey smoother and less stressful.

This is just one example showing how AI diagnostics can completely revolutionise the way healthcare insurance claims are processed and evaluated. You may have better and faster results with fewer chances of manual errors. Continue reading as we explore how AI in health insurance can redefine the whole industry with its potential benefits. 

Artificial Intelligence and Health Insurance Claims

If you closely follow the recent years, you may see how AI or artificial intelligence has transformed several industries like education, tourism, manufacturing, hiring, and more. And the landscape of health insurance is no different. In India, where the healthcare sector is consistently evolving, further integration of AI has proved to be helpful in several ways. 

For example, healthcare companies and centres are using AI detections to read patient data via proper algorithms and automated pattern recognition. Second, the claim management has become quite easy and smooth. Ai ensures you do not have to depend on outdated data and rule books for claim management. Instead, with AI claim management, you get consistently evolving reports based on data where you may easily identify errors without many unnecessary interventions. 

What's the Current Scenario?

According to a report by Business Standard, the average claim size of health insurance in India has grown by 11. 35% reaching ₹70,558. Another report by a recent popular newspaper revealed the challenges faced by policyholders in getting their health insurance claims processed. As per the report, only 43% of the policyholders were able to get their claims processed. Alternatively, others struggled with issues like eligibility, full disclosure, and much more.

With manual claim handling, one has to deal with understanding the “n” number of claims with medical intricacies, verifying their eligibility, documents, and much more. This may lead to human errors and delays. Now that we know that the demand for health insurance is growing in India, the country needs a more advanced approach. Leveraging AI can help health insurance companies streamline the whole process, making it more organised, quick and error-free. 

How AI-backed Diagnostics Can Help?

AI and its abilities to tap into data and process it accurately have not been hidden. The same can be quite helpful in claims management for health insurance companies. Here is how. 

Reading Data and Cross-Verification

AI can be used to read a significant amount of data related to claims around health insurance. AI can also be used to extract valuable information from a large pile of documents, such as medical bills. This can speed up the whole claim processing. 

Detection of Frauds

One of the biggest challenges faced by the insurance industry is dealing with fraud claims. Here as well, AI can prove helpful. With advanced design, AI uses patterns in reading claims, separately marking if there is a possibility of any fraudulent activities. This feature of AI helps insurers in two ways. First, it helps save them big on potential economic losses. Second, it fastens the processing of genuine claims. 

Predictive Reports

In addition to reducing human errors and fastening the claim process, AI can also help produce predictive reports. These reports can give valuable information on estimated claim amounts. Using old data and patterns, AI can gain information on several medical concerns, their costs, and much more which can help you estimate claim amounts. Thus, allowing insurers to make informed choices. 

Customer Help

AI chatbots can also come in handy to help customers offer real-time support. This allows them to interact and receive the latest updates on the status of their claims, clarity on their eligibility, and documentation while offering suitable guidance whenever and wherever needed. Thus, helping make the whole claim procedure a user-friendly and smooth experience. 

Automation for Further Help

AI can also help automate diagnosis and other processes involved. This can not only help reduce human errors and speed up the process but can also help improve consumer satisfaction. 

AI and Health Insurance: The Future Ahead! 

The phenomenon of integrating AI in health insurance is likely to grow more and more in the Indian landscape. As AI learning is evolving, the data sets are also being expanded. Thus, the future of AI integration in the healthcare sector looks hopeful. From diagnosis to reducing the dependency on the human workforce to helping customers resolve their queries, AI can come in handy at several stages of an insurance claim. 

Bottom Line

No doubt using AI will result in a drastic transformation for India's health and insurance sector. For healthcare providers, AI has opened new paths to modern-day diagnostics, which are automated and fast. It also helps them develop new minimally invasive techniques and do much more. For insurance companies, it has now become easy to identify fraud claims and read patients’ data in a much shorter time with AI. All in all, it won't be wrong to say that it has made way for a better, organised, and streamlined claims management system and digital health. 

>> Also Read: What is Covered and Not-Covered Under Mediclaim Policy

Disclaimers:All plan features, benefits, coverage, and claims underwriting are subject to policy terms and conditions. Kindly refer to the brochure, sales prospectus, and policy documents carefully.

Reference:

https://www.business-standard.com/amp/finance/insurance/average-health-insurance-claims-size-rises-11-35-yoy-in-fy24-acko-report-124092501178_1.html

https://economictimes.indiatimes.com/wealth/personal-finance-news/heath-insurance-claim-43-policyholders-faced-difficulties-some-had-to-wait-an-extra-day-at-hospital-survey/articleshow/109789790.cms?from=mdr