Stricter Criteria for Receiving Indemnity Insurance for Physical Therapy, Cataracts, and Thyroid Conditions

[Asia Economy Reporter Changhwan Lee] Starting as early as the second quarter, it is expected to become difficult to receive indemnity payments from actual expense health insurance if treatments such as manual therapy, cataract surgery, and thyroid treatment are received excessively.

This is because financial authorities have taken measures to reduce over-treatment of non-reimbursable items as the deficit in actual expense insurance worsens.

According to industry sources on the 13th, the Financial Supervisory Service (FSS) is currently working on strengthening the payment criteria for non-reimbursable items under actual expense insurance. The FSS formed a task force (TF) with the industry at the end of last year and began efforts to tighten the payment standards for actual expense insurance. The work is expected to be completed as early as the first quarter, and the strengthened payment criteria for non-reimbursable actual expense insurance will be applied from the second quarter.

The TF is reportedly mainly discussing strengthening payment criteria for non-reimbursable treatments such as thyroid, cataract, and manual therapy, which are considered the main causes of actual expense insurance premium increases due to over-treatment.

In the case of thyroid surgery, when a patient claims actual expense insurance benefits, the insurance company will verify with the medical institution whether the surgery was necessary due to over-treatment before paying the insurance benefits.

For cataracts, discussions are underway to deny insurance payments for surgeries performed solely for corrective purposes. However, detailed discussions are needed to establish precise judgment criteria.

Regarding manual therapy, from a certain number of sessions onward, patients will be required to submit a medical opinion from healthcare professionals confirming the necessity of manual therapy to the insurance company in order to receive insurance payments.

However, since the deficit in actual expense insurance is due not only to some policyholders' medical shopping but also to insurance companies' responsibility for poorly designed products, there are concerns that if insurance benefit payments are reduced, insurance companies will unfairly shift losses solely onto policyholders.

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