It was found that the actual loss insurance money paid for non-covered physical therapy such as manual therapy has already reached close to 1.6 trillion won this year alone. If this trend continues, it is expected that the amount of insurance payments paid out last year, which first reached 2 trillion won, will be broken again.
According to data received from the Non-Life Insurance Association by the office of People Power Party lawmaker Kang Min-guk, a member of the National Assembly's Political Affairs Committee, on the 31st, the actual loss insurance money paid for non-reimbursed physical therapy such as manual therapy, extracorporeal shock wave therapy, and proliferative therapy until August this year was 1.5 trillion. It was calculated to be 62.02 billion won (7.84 million cases).
Looking at it by year, the actual loss insurance premium for non-covered physical therapy, which was KRW 1.8468 trillion (9.362 million cases) in 2021, is increasing every year to KRW 1.8692 trillion (9.86 million cases) in 2022 and KRW 2.127 trillion (11.52 million cases) last year.
This year, if the current trend continues, it could surpass last year's record in the early 2 trillion won range.
When looking at the types of non-covered physical therapy, manual therapy was the most expensive at 945.178 billion won. Extracorporeal shock wave therapy was followed by KRW 348.487 billion, proliferation therapy at KRW 176.196 billion, and others at KRW 92.159 billion.
Non-covered physical therapy is a major cause of insurance payment disputes because the scope of doctors who prescribe and administer it is not set, and treatment costs vary widely depending on the medical institution.
When we looked at cases with a large amount of actual loss claims by insured (based on last year's claim amount), Mr. A, a man in his 40s, received inpatient and outpatient treatment at 8 medical institutions over a period of about 11 months, 342 times (23 times for manual therapy, 309 times for extracorporeal shock wave, 309 times for extracorporeal shock wave treatment). It was revealed that he received uncompensated physical therapy 10 times and claimed actual loss insurance of about 85 million won.
Another man in his 40s, Mr. B, alternated between two medical institutions for a year and was hospitalized over a period of about 6 months, receiving 694 sessions of uncompensated physical therapy (149 sessions of manual therapy, 191 sessions of extracorporeal shock wave, and 354 sessions of others), and suffered an actual loss of approximately 65 million won. Insurance claim was filed.
The non-life insurance industry cites the fact that, unlike the covered treatment covered by the National Health Insurance, there are no standards for non-covered treatment as the fundamental reason for this excess of physical therapy. Concerns continue to be raised that leakage of actual insurance benefits due to abuse of non-covered treatment may lead to increases in insurance premiums, thereby passing the damage on to many subscribers.
Representative Kang Min-guk said, “It is questionable whether receiving manual therapy hundreds of times and costing close to 100 million won has anything to do with normal patient treatment.” “Guidance from financial authorities is needed,” he pointed out.
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