Consumer Damage Related to Non-payment of Medical Insurance Claim Amount Continues to Rise

- Review of claims by insurance companies needs improvement in terms of application of co-payment ceiling -

Recently, an increasing number of cases have been reported where insurance companies pay less or refuse to pay claim payment by strengthening the insurance claim review process and applying co-payment ceiling* on non-benefit items such as cataract surgery or manual therapy.

* Co-payment Ceiling Policy : In order to lessen the burden of medical expenses, National Health Insurance Services pays the excess amount when the total amount of co-payment, excluding the expense for non-benefit items, exceeds the co-payment ceiling determined in consideration of the income levels(810 thousand~5 million 800 thousand Won, 2022).(Article 44(2), National Health Insurance Act)

Over the last four years, a total of 206* applications for damage relief related to non-payment of medical insurance claim amount have been filed with Korea Consumer Agency(President Jang Duck-Jin, KCA). The number is on the constant rise each year. Notably, 80 cases have been filed in 2021, which increased by 400.0% compared with 16 cases filed in 2018.

* Number of applications for damage relief related to non-payment of medical insurance: 16 (2018) → 36 (2019) → 74 (2020) → 80 (2021)