Kathmandu. Although the health insurance program is being run across the country, the claim and payment process is becoming complicated. A large number of claims are being made every day, but the amount that is yet to be paid is increasing.
The Health Insurance Board has engaged several health service providers to run the health insurance program. The Insurance Board is running the program by signing an agreement with health service providers to make it easier for the people to avail this service.
According to a white paper issued by the Insurance Board, around 30,000-40,000 claims are received daily from service providers. These claims are worth around Rs 70 million. However, the insurance board has the capacity to verify only 6,000-7,000 per day.
Due to the high gap between claim and verification capacity, the last fiscal year 2080. According to the white paper, the claims of 81 are still to be tested. As of mid-March last year, the board has claimed that it has not been verified and there are about 9 million claims. According to the white paper, the health insurance board, service providers and the insured are all in trouble due to adequate skilled manpower and the methods and procedures adopted.
Due to these reasons, the amount due to payment is increasing. Current fiscal year 2081. The insurance board has paid Rs 16.45 billion to the service providers as claims till February 2018. According to the white paper, a total of Rs 24 billion will be left for payment by the end of this year. It seems to be a challenge to develop the ability to make payments on time.
