Will the September National Assembly Simplify Claims for Silseon Insurance?... Medical Community Expresses Dissatisfaction

Giving Up Insurance Claims Due to Complex Procedures
Medical Institutions → Intermediary Agencies → Insurance Companies Transmission
No Risk of Medical Information Leakage Due to Encryption

[Asia Economy Reporter Oh Hyung-gil] The National Assembly has begun the legislative process for the 'Simplification of Claims for Actual Medical Expense Insurance.' However, the medical community is opposing the move, arguing that it shifts the burden of insurance claim processing onto medical institutions under the guise of consumer convenience. Attention is focused on whether this decades-long controversy can be resolved.

According to the insurance industry on the 3rd, the lawmakers who proposed bills related to the simplification of actual expense insurance claims in the 21st National Assembly are Jeon Jae-su of the Democratic Party of Korea and Yoon Chang-hyun of the People Power Party.

Jeon’s amendment is characterized by allowing insurance companies to build and operate a computerized system for simplifying actual expense insurance claims or to entrust this to a specialized intermediary institution. The specialized intermediary institution receives insurance claim documents electronically from hospitals or medical institutions and then transmits them to the insurance companies.

Lawmaker Yoon also proposed an amendment to the Insurance Business Act to promote the simplification of actual expense insurance claims through the Health Insurance Review and Assessment Service.

Over the past decade, bills related to the simplification of actual expense insurance claims have been consistently proposed but have repeatedly failed to pass the National Assembly due to opposition from the medical community.

For actual expense insurance, which has '38 million subscribers,' claimants had to obtain a large volume of documents from hospitals and submit them directly to insurance companies when filing claims. Most subscribers often gave up on claiming insurance benefits due to the small claim amounts and complicated procedures.

The bill related to claim simplification stipulates that if requested by the patient, hospitals must mandatorily send medical expense proof documents to the insurance company. This greatly enhances convenience for both insurance companies and consumers.

However, the medical community opposes this, arguing that if insurance companies intervene in the review of medical fees based on accumulated data, leading to reductions or refusals of payment, medical institutions will have no choice but to provide medical services while being cautious of insurance companies, raising concerns that healthcare could become subordinate to insurers.

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In response, the Korean Hospital Association, Korean Medical Association, Korean Oriental Medicine Association, Korean Dental Association, and Korean Pharmaceutical Association have also submitted opposition opinions to the National Assembly regarding the bill amendment. The Korean Medical Association urged, "The National Assembly should immediately repeal the bill simplifying actual expense insurance claims that abuses medical institutions, which should be dedicated to patient care, solely for the benefit of private insurance companies."

To resolve this controversy, there is also a movement to add provisions that intermediary institutions or the Health Insurance Review and Assessment Service only transmit individual medical data to insurance companies without aggregating it.

An insurance industry official said, "Both ruling and opposition parties are positively viewing the aspect of consumer convenience," and added, "It is expected to be passed this year without fail."

This content was produced with the assistance of AI translation services.