About superclaim

The problem we kept running into

In India a hospital stay brings a second problem with it: the claim. Families learn about room rent limits, co-pays and deductions at the discharge counter, when it is too late to choose differently. The insurer sees the policy. The hospital sees the bill. The patient is the only one who has the whole problem, and usually the one with the least information.

• The insurersees the policy
• The hospitalsees the bill
• The patienthas the whole problem, and the least information

The numbers show how often it goes wrong. In 2024-25, insurers disallowed 13.98% of the amount claimed under policy terms and repudiated 8.61% of claims by value, across the whole industry (IRDAI Annual Report 2024-25). Some of that is correct under the policy. Some of it traces back to things a family could have known before admission, or papers a desk could have sent earlier.

How we started

Why claims are slow today

Most of the delay is not bad intent. It comes from systems that were never built to talk to each other.

• One case, many portals. Each insurer and each TPA runs its own portal. A hospital desk re-types the same patient, the same diagnosis and the same estimate into whichever portal that patient's policy uses.
• Paper in a digital world. Documents move as scans and email attachments. A query from the insurer comes back, the desk answers, and the clock keeps running.
• Billing and the desk work apart. In many hospitals the billing system and the insurance desk do not share data as it happens. So at discharge the family waits for the final bill before the final authorisation request can even go out.
• Lists that go stale. Cashless hospital lists are long documents updated on the insurer's schedule, not the patient's.

IRDAI has set the pace it expects: a decision on a cashless request within one hour, and final discharge authorisation within three hours (Master Circular on Health Insurance Business, May 2024). Old systems make those clocks hard to meet.

• 1 hour for a decision on a cashless request
• 3 hours for final discharge authorisation

Where claims are going

We think the next few years change the claim more than the last twenty did. The pieces are already arriving:

• Shared rails. The National Health Claims Exchange, run by the National Health Authority, lets hospitals and insurers exchange claims in one standard format instead of a portal per insurer.
• Clocks that are enforced. The one-hour and three-hour rules turn speed into an obligation, not a courtesy.
• Software that does the paperwork. AI agents can prepare a pre-authorisation, check a bill against the policy and chase a pending query in minutes. People still make the decisions.

Here is what we think a hospital stay will feel like when these pieces meet:

1. You know before you choose. Which hospitals are cashless for your plan, and what you will pay at each, confirmed before you pick one.
2. Approval without the wait. The pre-authorisation goes out within minutes of the doctor's advice, and you see its status as it moves.
3. No surprise at the counter. The bill is checked against your policy before discharge, so deductions are prevented instead of explained afterwards.
4. One thread, start to settlement. Every message, estimate and approval in one place, with the same person answering.

What we are building

Our aim is simple to say and hard to do: no family in India should be surprised by a hospital bill.

Today that means a person who reads your policy, calls the hospital desk and stays with your claim. Over time it means doing the same for every hospital and plan we cover, with every answer confirmed and dated, not guessed. We also work with hospitals so their insurance desks can answer faster and admit more patients cashless. That is how we are paid, and it keeps us on the side of getting your claim through.

How we work

• A person, not a bot, reads your policy and calls the hospital desk. See how we check cashless.
• Free for you. The hospital that admits you pays us. If two hospitals come out equal on your money, we show the one we work with first, and we tell you when we do.
• Your documents are yours. We use them only for your case and delete them 90 days after it closes. See our privacy page.
• No medical advice. Which treatment you need stays with your doctor.

superclaim is a proprietorship registered under Udyam (UDYAM-HR-20-0044082), Palwal, Haryana. Write to us at [email protected] or on WhatsApp at +91 97283 75686.

Have a hospital stay coming up? Send your policy on WhatsApp and a person checks it for you.

Reviewer

Shine Rajpal founded superclaim and reviews every policy page and guide on this site. Each figure is checked against the insurer's own policy wording or the IRDAI circular it comes from, with the page number, and checked again every month. If you spot an error, write to [email protected] and we reply within 7 days.