Dealing with medical bills can be stressful, and this is even more so when it comes to emergencies. While purchasing a health insurance plan, one of the most significant questions is: How quickly will the insurance company process your health insurance claims when you need their help?
ACKO operates on a largely paperless and technology-driven model. Claims are submitted digitally, and workflows are designed to reduce manual intervention. This setup is intended to streamline the claim process and reduce turnaround time.
So, how do health insurance claims work at ACKO?
There are two types of claims in insurance:
Cashless Claims: You get treated at a hospital that is part of the insurer’s network, and the insurer settles the bill directly with the hospital.
Reimbursement Claims: You pay the bills and then claim a refund from the insurer.
The way each claim is handled isn’t identical, so the time it takes can vary from one type to another.
So, how is claim speed measured?
When people ask how fast a claim gets settled, what they really want to know is how long the insurer takes to review the documents and give a final decision.
Turnaround Time (TAT): This is the time that elapses between the submission of a claim and the final decision on the same.
Cashless authorisation time: This refers to the time taken from when a network hospital sends a cashless request to when the insurer responds.
Claims settled within a specific time frame:
Another way performance is measured is by looking at the percentage of claims settled within a set period, such as three months. The insurance regulator, IRDAI, publishes this data every year so customers can see how insurers are performing on overall settlement timelines.
As per IRDAI’s release for FY 2024–25, Acko General Insurance Ltd. reported that 99.98% of claims were settled within three months. Several other insurers also reported high settlement ratios.
How fast are cashless claims approved by ACKO?
For cashless claims, the time factor is based on documentation and completeness.
As per IRDAI’s guidelines on cashless health insurance, insurers are required to follow time-bound procedures for cashless claim processing. Insurers are expected to respond to pre-authorisation requests immediately wherever feasible, and typically within 1 hour of receiving complete details from the hospital. Additionally, insurers must provide final discharge authorisation within 3 hours of receiving the discharge request.
These timelines are intended to minimise delays during hospital admission and discharge.
Since ACKO operates digitally, claim documents are shared and verified online with network hospitals, which helps reduce paperwork.
Actual approval timelines may vary depending on factors such as policy terms, eligibility, and the completeness of documentation. Delays can occur if additional clarification or documents are required. Effective coordination between the hospital and the insurer is also important for timely processing.
How long do reimbursement claims take?
Since reimbursement claims involve checking all the documents, bills, reports, prescriptions, and confirming that the expenses match the policy coverage, they generally require more detailed review.
As per IRDAI regulations, insurers are required to settle or reject a claim within 30 days from the date of receipt of the last necessary document. If an investigation is required, it must be completed within the prescribed timelines, and the overall processing period cannot exceed 45 days from the date of receipt of the last required document.
In case of delays beyond the regulatory timelines, interest may be payable to the policyholder as per applicable IRDAI norms.
Factors that affect claim approval speed
Several things can affect the speed at which an Acko insurance claim is processed:
Complete Documentation: The absence of bills and reports might delay the approval process.
Policy Coverage: When the claim is directly covered by the policy, it is processed quickly.
Hospital Details: Network hospitals tend to provide faster approvals.
Timely Intimation: Notifying the insurance company on time helps to quicken the procedure.
Regulatory compliance: IRDAI guidelines are a baseline for all insurers.
How to get faster claim approval in ACKO?
The Claim Settlement Ratio (CSR) is an important performance indicator. It indicates the percentage of claims settled by the insurer within a stipulated time period (usually within 3 months of the claim being filed).
Submit complete documentation: Ensure all hospital bills, discharge summaries, prescriptions, and reports are uploaded clearly.
Notify the insurer on time: Inform the insurer or initiate the claim as early as possible, especially for planned hospitalisation.
Choose network hospitals (for cashless claims): Coordination is generally smoother at network hospitals.
Review policy coverage: Check coverage limits, waiting periods, and exclusions before filing the claim.
Respond quickly to any queries: If additional documents are requested, submit them without delay.
Final Thoughts
How quickly a claim is approved depends on a mix of regulatory timelines and practical factors. IRDAI has set time-bound requirements for both cashless and reimbursement claims, but the actual experience can vary from case to case.
More often than not, approval speed depends on simple, practical things. If your policy clearly covers the treatment, your documents are complete, and the hospital and insurer are aligned, things tend to move faster.