TEMPO.CO, Jakarta - Health insurance services, especially hospital cash plan, remain susceptible to fraud. Togar Pasaribu, Executive Director of Indonesian Life Insurance Association (AAJI), said that several insurance companies were aware of the fraudulent practices and have discussed the issue.
Togar explained that hospital cash plan is an insurance product where the insurance company will provide reimbursements for medical treatment paid by policy holders. "[An example of] hospital cash plan is when a policy holder was administered to a hospital, then the insurance company will provide Rp 1 million each day. This method is what fraudulent customers often exploit," Togar said, as quoted by Bisnis.com.
Togar added that the fraud was possible with the help of certain medical staffs or hospital. Togar said that on several cases, policy holders were not even sick. However, recommendation letters and medical receipts were nevertheless submitted to insurance companies for claims.
Togar added that insurance companies have black listed several names of individuals who are considered to be low-earning people, but can own up to seven health insurances with large number of claims.
"[Fraudulent practices] have and still happening. Therefore, unpaid claims cannot be fully balmed on insurance companies," Togar said.
BISNIS.COM
