The healthcare industry is experiencing a significant shift as artificial intelligence adoption by providers is driving up healthcare costs. According to recent industry analysis, starting in 2025, many health insurers reported seeing an increase in claims severity when compared to 2024 claims, with more claims being coded to reflect complex levels of care. This trend has sparked speculation across the healthcare industry that providers' use of AI could be increasing the amount of money they're paid by insurers. The impact is particularly evident in how healthcare providers bill insurers, as every claim includes a series of healthcare codes that signify the type and complexity of care provided to patients, with insurers evaluating these codes to determine payment amounts.
Having both a personal health insurance policy and employer-provided cover can provide significant financial protection when hospital bills exceed coverage limits. According to expert advice from Ask Mint Insurance, having two policies does not mean duplicate reimbursement rights - claims generally need to be coordinated between insurers. The second policy can be used to meet eligible portions of bills that remain unpaid after the first claim is settled, but policyholders must disclose all relevant covers and maintain copies of medical and claim documents. This coordination becomes increasingly important as AI-coded claims for complex care are playing a meaningful role in increasing healthcare costs and, in turn, the premiums people pay for their health plans.
A recent Ask Mint query involving a senior citizen who underwent valve replacement surgery costing ₹30 lakh illustrates the coordination challenges. The patient had a ₹10 lakh personal health insurance policy, while a separate corporate policy provided ₹20 lakh of cover for the son. The complication arose when the personal insurer processed the claim for nearly two months, while the corporate insurer wanted original documents that had already been submitted to the first insurer. As reported by Livemint, the personal policy would be processed first, with the policyholder then approaching the corporate insurer for eligible residual expenses. This case highlights how claims severity increases can result in higher payments to care providers, making coordination between insurers more critical than ever.
For successful coordination between insurers, policyholders must provide specific documentation. According to the expert advice, a claim settlement letter from the first insurer is crucial, establishing the total claimed amount, approved amount, and remaining unpaid balance. An insurer-attested copy of claim documents can also be submitted when originals are held by the first insurer. The second insurer will need evidence of what the first insurer has already paid, making proper documentation essential for smooth processing. This becomes particularly important as AI-coded claims for complex care are playing a meaningful role in increasing healthcare costs and premiums, requiring more detailed documentation and coordination between insurers.
Prolonged delays by the first insurer can hold up second claims, creating financial hardship for policyholders. The expert advises pursuing the first insurer for faster resolution rather than allowing matters to remain pending. If routine follow-ups fail, policyholders can escalate to senior officials, Third Party Administrators (TPA), or the insurer's internal claims team. The insurer's grievance-redressal officer can be approached if issues remain unresolved, ensuring that multiple health policies provide additional financial protection without creating duplicate reimbursement rights. With AI-coded claims for complex care increasing healthcare costs, these resolution strategies become even more critical for policyholders managing dual health insurance policies.
