HDFC Ergo has announced the launch of cashless post-hospitalization claims, set to roll out in the third week of December 2024 through its app, Here. As the name suggests, post-hospitalization expenses cover costs incurred on doctor consultation, diagnostic, medicine etc after a person is discharged from the hospital, provided these expenses are directly linked to the illness or treatment for which the hospitalization took place.
Until now, policyholders of HDFC Ergo had to bear these costs initially and then wait for reimbursement form HDFC Ergo, but this new feature aims to change that. Using the Here app, policyholders of HDFC Ergo can now book OPD consultations, diagnostic tests, and even purchase medicines directly, without paying any cost, if covered under post-hospitalisation. HDFC Ergo claims that the app already has 70 lakh downloads, with 4 lakh active users, and this new feature is expected to enhance its utility further.
There are clear advantages for the policyholders who won’t have to spend their money first and then go through the hassle of reimbursement. The process becomes seamless, from hospitalization to post-hospitalization, with reduced chances of delays or deductions of claim.
For HDFC Ergo, it’s also a strategic move. By routing these services through its network of hospitals, labs, and pharmacies—where rates are pre-negotiated—the company can save costs. For example, a doctor’s consultation at Max Hospital, which might cost ₹1,500 to a person (and would then need to be reimbursed by Ergo later at full amount), could cost only ₹1,000 when booked through the app, thanks to the agreed rates between the hospital and Ergo. This results in a ₹500 saving per consultation for HDFC Ergo, leading to substantial cost savings when the majority of policyholders use this service through the app.
On paper, it looks like a win-win situation for both the insurer and the insured. But as always, the real-world execution isn’t without challenges. One issue is the reluctance of hospitals to accept bookings through insurance apps. Since insurance companies negotiate lower rates on these services than cash patients, hospitals may deprioritize insurance patients, particularly for OPD consultations and diagnostics, which aren’t major revenue streams for them unless tied to a hospitalization.
Another concern is that HDFC Ergo might not encourage reimbursement claims for post-hospitalization expenses if they’re not routed through the Here app. This could lead to delays or deductions, leaving policyholders with fewer choices. Not all hospitals or labs may be part of the insurer’s network, and if you opt for a non-network provider, you might face claims being reduced under “reasonable and customary” clause.
Perhaps the most significant hurdle is the ease of booking services through the app itself. Often, hospitals or doctors show unavailability for appointments booked via these platforms, likely due to the reasons mentioned earlier. While this initiative could certainly save costs for HDFC Ergo, whether it will genuinely revolutionize the insurance industry or significantly improve the customer experience remains to be seen. For now, it’s a step forward—but not without its share of caveats.
