"The premium goes up once every three years. I'm paying 98,000 won now? I think it's the insurance company's tyranny for not giving me what I deserve. I'll get it anyway. Because it's my money."
Park, in his 50s, who lives in Gyeonggi-do, visited an eye hospital in Gangnam-gu, Seoul last March.
The hospital recommended multifocal intraocular lens surgery because he had cataracts, and he underwent cataract surgery in both eyes.
The total cost is 14 million won.
Park, a first-generation indemnity medical insurance subscriber, sent related documents to the insurance company after surgery and waited for the insurance payment to be paid, but the insurance company requested a third-party advisor's opinion.
Park responded to this, and the consultant judged that "it is difficult to make a uniform decision" about the necessity of Park's cataract surgery in the statement of opinion.
However, the insurance company interprets this as "a finding that it is difficult to see that cataract surgery is necessary" and has been refusing to pay the insurance money so far.
'Indemnity insurance', also called 'second health insurance', with 39 million Koreans enrolled.
Like Mr. Park, the number of cases of conflicts with insurance companies over payment of insurance premiums among subscribers who underwent cataract surgery has increased significantly this year.
The reason insurance companies are strict about paying out cataract loss insurance is because of the continuously rising loss ratio.
According to the Non-life Insurance Association, cataract indemnity insurance reached an all-time high of 455 billion won in the first quarter of this year, and the related loss ratio was 131% last year.
Insurance companies suspect that some eye hospitals are encouraging patients to have unnecessary surgeries.
In particular, it is taking a strict stance against oversurgery and insurance fraud, and there is concern that even insured persons who have legitimately undergone cataract surgery in the process may not receive insurance benefits.
According to the Insurance Association's 'Status of cataract surgeries in some ophthalmic hospitals in March 2022', an ophthalmic hospital in Seoul with three doctors performed 2,128 cataract surgeries for insured persons in one month.
Eye hospitals with a large number of surgeries are protesting that "patients who were concerned about the loss of indemnity insurance benefits were flocked to a specific point in time," and there was no illegal mediation.
The 'triangular conflict' between patients, insurance companies, and hospitals over indemnity insurance.
Experts point out that this is because the initial design of indemnity insurance itself was poor, and the government, which had to reconcile conflicts, was behind.
In the 386th News Story, which will be aired this week, we would like to discuss the 'excessive' controversy surrounding cataract indemnity insurance and its solutions.