KOCHI: Sasidharan (name changed) fell down the stairs and was injured. The doctor’s report showed a tear in the ligament. As per the diagnosis, he underwent the necessary treatment. But when the documents were submitted for claims, the insurance company stated the cause of the tear in the ligament was chronic and not an acute injury, and hence does not qualify for compensation.
That’s when Sasidharan approached the Seven Sigma Healthcare Solutions, a Kochi-based consultancy startup focusing on settling claims rejected by insurance companies. Consequently, the company was able to prove to the insurance company that Sasidharan deserved the compensation. The startup, which was started three months ago, is a one-of-its-kind consultancy firm providing claim assistance exclusively to all insurance policyholders - be it any health insurance scheme or company - in Kerala.
“There are a lot of problems pertaining to the health insurance claims,” says Udayachandran C P, one of the founder-directors. “There are cases when the insurance companies reject or deny claims stating various technical and medical reasons. With the help of dedicated doctors, the trained professionals at the company verify whether these reasons are valid or not.”
The startup focuses on health insurance claims. “This is because these cause a lot of heartburn to the policyholders. In most of the cases, the issues are so subtle and technical that the public would not understand. This is what the insurance companies attempt to capitalise. This is unfair,” says Udayachandran, who worked in the insurance sector for decades.
According to him, the company follows ‘No Cure, No Charge Rule’. “We don’t charge up-front. Once the claim is settled, a percentage of the claim is decided as the payment for the consultancy,” he says.
Other than health insurance claims, the company also handles revenue management of the health schemes in hospitals. “Different hospitals sponsor different schemes with the involvement of various organisations. Running these schemes prove to be a challenge for hospitals,” says Udayachandran.
Assistance is also offered for flood claims. “There is a lot of documentation involved while handling claims. We help policyholders with this as well,” he says.Other than Udayachandran, the startup includes three other founder-directors: Shobha Moorthy, Jyothi Warrier and Dr Satheesh Warrier. Three months since its inception, the company has handled all cases successfully.