[Opinion] Hope for the Computerization of Actual Expense Insurance Claim Procedures Next Year...

What do consumers who have purchased insurance want the most? Naturally, it is to receive the insurance payout properly when they need it. This seems like a very obvious matter, but there are often cases where this common sense does not apply.

South Korea’s health insurance system is superior compared to other countries, but the medical expenses borne by consumers are not insignificant. As of the end of June 2020, 38 million Koreans have purchased 실손의료보험 (actual expense medical insurance) to reduce their medical cost burden.

실손의료보험 can be considered a second health insurance. It is very convenient for consumers to purchase 실손의료보험. They can search all currently available insurance products by company and price at once on the internet, and when signing a contract, they do not need to visit the insurance company in person but can conveniently subscribe using a smartphone. Payment of premiums can also be done via automatic transfer, and using smartphones makes it extremely convenient.

However, when consumers who have paid premiums try to claim insurance money from 실손의료보험, many give up due to the difficulty of submitting the required documents, so the expectations they had when purchasing insurance are often not met.

Even nowadays, consumer complaints about the inconvenient claim process of 실손의료보험 continue to be raised through the media.

Currently, to claim insurance money, consumers must visit the hospital to obtain receipts and detailed medical bills in paper form, then visit the insurance company to submit them or send them by mail or fax. The slightly improved method is to take photos of the paper documents with a smartphone and send them, but even this requires the consumer to visit the hospital first to get the paper documents issued.

If the consumer did not collect the documents at the hospital during their visit, they must revisit the hospital, which becomes very cumbersome and inconvenient if the claim amount is small. This results in situations where consumers have to give up claiming insurance money even after purchasing insurance.

South Korea is a country with very advanced IT technology. In the past, when a traffic accident occurred and one wanted to apply for insurance money or national pension, they had to visit the police station in person to obtain a traffic accident confirmation certificate and submit it. But now, using the administrative information sharing network, electronic documents are sent directly from the police station to the National Pension Service without issuing paper documents. If only a little institutional support is provided, it does not seem very difficult to solve the inconvenience caused by submitting paper documents.

In the case of 실손의료보험, if patients could directly designate their information electronically and send it to the insurance company, the problem of giving up claims due to the inconvenience of issuing paper documents could be resolved.

Some in the medical community express concerns that if information is transmitted via electronic networks, personal information could be indiscriminately leaked and the workload of medical institutions could increase. These are reasonable and valid points. However, Korea’s advanced IT technology has already addressed these concerns, and currently some university hospitals such as Severance have introduced services that allow patients to directly designate necessary documents and send them to insurance companies to facilitate 실손의료보험 claims.

The 국민권익위원회 (Anti-Corruption and Civil Rights Commission) recommended improvements to the system in 2009 due to criticisms that the 실손의료보험 claim process is inefficient and inconvenient. However, even after 10 years, citizens still experience inconvenience in claiming insurance money. During this time, the National Assembly and government have continuously worked to computerize 실손의료보험 claims, and in the 20th National Assembly, a bill to amend the Insurance Business Act to provide legal grounds was proposed but was never discussed and was discarded.

Shortly after the 21st National Assembly was formed, ruling party members Jeon Jae-su and Ko Yong-jin, and opposition member Yoon Chang-hyun, reintroduced bills to computerize 실손의료보험 claims under the Insurance Business Act. Since both the ruling and opposition parties share the same awareness of the problem and are working to resolve the inconvenience of the 실손의료보험 claim process, we hope that this time the computerization of 실손의료보험 claims will definitely be realized.

Choi Mi-su, Professor at Seoul Digital University (President of the Korean Financial Consumer Association)

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