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Blockchain for non-cash insurance claims for OPD
OPD insurance covers those expenses that are incurred on an outpatient basis and do not include hospital admission. They include fees for medical advice, the cost of medicines, laboratory tests, some dental treatments, etc.
According to data provided by the Insurance Regulatory Authority (IRDA), the cost of health insurance in India is 62%. (Source: http://www.thehindu.com/business/out-of-pocket-spend-makes-up-62-of-health-care-costs/article21860682.ece). It is a significantly high value and is caused by high outpatient expenditures (OPD).
Although health insurance plans cover the costs of hospitalization, the scope of OPD expenditures is limited in nature. In fact, in many systems, you are forced to bear the costs of OPD yourself because they have excluded OPD coverage.
Most health insurance programs do not pay for OPD costs. Some of them who provide insurance have limited insurance. Expenditure on OPD is paid either up to 5% to 10% of the sum insured or up to a certain absolute amount (for example Rs 500,000 or Rs 10,000). In addition, a waiting period may apply before the OPD can be covered. Premiums are also higher in the case of schemes with a provision of OPT, which makes these schemes unattractive.
Calls with OPD entitlements:
OPD coverage is usually not covered in many plans or is covered with less certainty due to the challenges it poses in your country. Some of the challenges include the following:
Counterfeit claims
Filing a false insurance claim for OPD expenses is quite easy when individuals can agree with pharmacists, doctors, diagnostic centers to make false or inflated accounts for an OPD insurance application. It is difficult for insurance companies to assess the validity of such claims.
Basic costs
The requirements for OPD, especially those related to consultation with a doctor, are limited. They can range from Rs.200 to Rs.1500. Against such small claims, the administrative costs incurred in validating and settling a claim are high. Due to the costs incurred in connection with the amount of the insured event, insurance companies are not interested in offering OPD coverage and individuals also consider it problematic.
Best In Relation To The Premium
From the customer's point of view, OPD coverage is not fruitful. It comes at a higher premium level, provides a limited amount to cover and also includes higher premium expenses. Therefore, even policyholders do not want to obtain OPD coverage in their health insurance companies.
Cashless settlement of OPD claims:
The way forward is cashless settlement of OPD claims through blockchain technology solutions for a distributed database and smart contracts that can not only create seamless claims payments but also resolve disputes, if any. This automation would have an environment of trust regarding the verification, assessment and payment of claims, as well as the detection of fraud and the reduction of operating costs. The purpose of settling non-cash receivables is to ensure the validity of your receivables and reduce the number of false receivables.
Regardless of the problems associated with OPD coverage, the fact that healthcare costs are significant cannot be ignored. The probability of entering the hospital is lower than the probability of incurring the cost of OPD. With consultation fees ranging from Rs.200 to Rs.1500 and thousands more obtained for clinical trials and medications, the cost of OPD has become relatively significant.
From the policyholder's point of view, the coverage for OPD 2 has a clear advantage. First, you get coverage for your small medical expenses and second, you can claim income tax deduction under Section 80D on premiums paid.
