실손의료보험 보험금청구 간소화에 관한 법적 연구 - 보험업법 개정(안)을 중심으로 -

Abstract

The problem has been raised that the traditional claim method, called claim for medical insurance, does not correspond to the development of Korean IT technology. In this paper, the author critically considers that the existing insurance claim procedure is not valid, and reviews the contents of the main legislation (proposal) proposed to the National Assembly. Currently, our society is rapidly changing from the analog era to the digital era. We are living in an era where various financial payments are made with just one smartphone. Nevertheless, the procedure for claiming insurance does not reflect the new era. In the insurance industry, consumer-oriented digital methods from designing or developing insurance products to contract management and insurance payment management are very important. Among these, one of the most important factors is the simplification of the claim process for medical insurance claims of policyholders. The simplification plan for indemnity insurance is based on the content that the insurance claim is made electronically when a patient makes a request to the hospital without paper documents. While focusing on literature research, this study adopts an analytical method that accommodates difficulties encountered in the working world and a review method of major legislation (proposal) proposed by the National Assembly. We favored the simplification of medical insurance claims through insurance intermediaries, but pointed out the problems that may arise when operating this method. The simplification of insurance claims is expected to dramatically improve the efficiency of insurance companies and the convenience of consumers, but the medical community opposes this because of side effects such as restrictions on the use of patient medical information and insurance subscriptions, and leakage of patient personal medical information. This appears to be the biggest obstacle to simplifying insurance claims. A few ways to solve this problem are suggested. The method of claiming insurance by issuing a paper receipt is not suitable for the future. In order to solve the waste of human resources or administrative costs, a plan for simplifying insurance claims must be implemented.