Insurance Industry vs Medical Sector, Differences Over Computerization of Real-World Insurance Claims

Legislative Public Hearing on the Amendment to the Insurance Business Act

[Asia Economy Reporter Ki Ha-young] At a public hearing discussing the simplification of claims for indemnity health insurance, the insurance industry and the medical community reaffirmed their differences in positions.

On the 10th, four members of the National Assembly, including Kim Byung-wook of the Democratic Party of Korea, a member of the National Assembly's Political Affairs Committee, held the 'Legislative Public Hearing on the Computerization of Indemnity Health Insurance Claims' at the Irum Center in Yeouido, Seoul.

Currently, five bills amending the Insurance Business Act, which include grounds for the computerization of indemnity insurance claims, are pending in the National Assembly's Political Affairs Committee. All five bills require medical institutions to comply with requests from insurance contract holders to transmit documents necessary for insurance claims unless there is a justifiable reason not to do so.

At the event, Eun Sung-soo, Chairman of the Financial Services Commission, said in his congratulatory remarks, "The bill on the computerization of indemnity health insurance claims should find solutions from the perspective of 39 million medical consumers," adding, "I hope this public hearing will be an opportunity to return to the public the precious time wasted receiving unclaimed insurance money and documents that are discarded."

At the meeting, the insurance industry demanded that medical institutions provide insurance claim documents digitally to improve consumer convenience and reduce socio-economic costs, but the medical community opposed this, citing concerns over patient medical record leaks and misuse of information by the Health Insurance Review and Assessment Service.

Professor Na Jong-yeon of Seoul National University (Department of Consumer Science), who presented the first paper, stated, "Several surveys have shown that when medical expenses are small, consumers feel the cost outweighs the benefit of claiming and thus give up their rightful (insurance) claims," and argued, "It has been empirically confirmed that computerization of claims is necessary to reduce consumers' time, effort, and costs."

The second presenter, Seo In-seok, Insurance Director of the Korea Hospital Association, emphasized, "The party responsible for fulfilling indemnity insurance contracts is the insurer, so it is unfair for medical institutions to be the party transmitting documents," and added, "Improving the inconvenience of contract holders is the insurer's responsibility."

Shin Young-soo, a lawyer at Yulchon LLC who participated as a discussant, said, "The medical community opposes on the grounds that they are not parties to the insurance contract, but the Medical Service Act allows electronic provision of medical records to third parties, and the Credit Information Act stipulates that upon request by the subject of credit information, transmission to third parties such as financial institutions is permitted," interpreting that "since patients hold the status of medical record holders, cooperation for the benefit of patients (with their consent) is necessary."

Park Ki-jun, Head of the Long-term Insurance Department at the General Insurance Association, a discussant from the insurance industry, rebutted, "Medical institutions already issue indemnity claim documents, so defining participation in service improvements to enhance claim convenience as a new obligation for medical institutions is inappropriate."

In response, the medical community expressed concerns about the potential leakage of patient personal information and arbitrary misuse of patient medical information by the Health Insurance Review and Assessment Service. Ji Gyu-yeol, Insurance Advisory Committee member of the Korean Medical Association, argued, "Medical institutions are fundamentally places that provide medical care, not administration," adding, "If related documents are transmitted without going through the patient, there is a high risk of information leakage without the information subject?the patient?being aware, and if leaked, disputes over responsibility among medical institutions, intermediary agencies, and insurers may arise." He further pointed out, "Especially if the review and assessment service is entrusted with intermediary tasks, the government could use this as a management tool to scrutinize hospitals' non-reimbursable medical practices."

Kim Jun-hyun, Director of the Health Policy Participation Research Institute, argued, "The amendment of related laws to simplify insurance claims is ultimately aimed at accumulating information of private insurance subscribers using the public insurance network and utilizing it for product development and reducing management and operating costs."

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