Jurnal Multidisiplin Sahombu
Vol. 5 No. 01 (2025): Jurnal Multidisiplin Sahombu (2025)

Analysis Of The Causes Of High Inpatient Claim Ratio At Intra Asia Insurance In 2024

Fresitinawati, Senintyas (Unknown)
Nurrahim, Eka Julianti (Unknown)
Setiawan, Muhammad Raja Nararya (Unknown)
Rakhman, Sitti (Unknown)



Article Info

Publish Date
20 Jan 2025

Abstract

PT. Intra Asia, located in South Jakarta, offers health insurance products such as outpatient, inpatient, dental care, glasses, and maternity coverage. Since its launch in 2017, the company has served 17 clients, including new and renewal accounts. Its market focuses on companies providing additional health protection for employees. In 2022, five client companies reported a claim ratio exceeding 120%, with inpatient claims averaging over 90% and surpassing outpatient claims in 2023. Data for December 2023 shows 5,234 outpatient claims and 2,503 inpatient claims. In 2024, 142 inpatient claims were reported, with 97 cases (5%) experiencing lost monitoring, contributing to extended hospital stays and higher costs. The issue stems from insufficient monitoring due to reliance on third-party administrators (TPAs). While the company adheres to its SOPs, including regular claim ratio reviews (every 3–6 months), gaps in monitoring at hospitals have led to inflated inpatient costs, emphasizing the need for stricter follow-ups.

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Journal Info

Abbrev

JMS

Publisher

Subject

Arts Civil Engineering, Building, Construction & Architecture Economics, Econometrics & Finance Environmental Science Law, Crime, Criminology & Criminal Justice

Description

Jurnal Multidisiplin Sahombu is at the scope of the multidisciplinary intended is only limited to the following points, Economics Politics Public Business Civil society, Finance Culture Arts ...