₹15,100 crore was disallowed, not rejected. The difference is where your money goes.

In FY2023-24, health insurers in India were presented with claims worth about ₹1.17 trillion. They paid ₹83,493 crore. They repudiated ₹10,937 crore — claims rejected outright. And they disallowed ₹15,100 crore — money cut line by line from claims they accepted.

Together that is roughly 22 per cent of everything claimed, by value. Most hospitals think about the 9 per cent. The 13 per cent is bigger, quieter, and far more addressable.

What the deductions actually are

Almost none of it is a clinician second-guessing your clinician. The recurring heads are structural, and they are set by the patient's policy rather than by your treatment:

• Room-rent capping with proportionate deduction. The one that costs the most. If the patient occupies a room above their eligible category, the insurer does not merely cut the room differential — it applies the same proportion across associated charges. Surgeon's fee, OT, investigations, nursing. A modest room upgrade can take a double-digit percentage off the whole bill.
• Sub-limits on named procedures, cataract and joint replacement typically, and on ICU.
• Consumables exclusions — gloves, syringes, PPE and similar, which have been estimated at as much as 5 per cent of a hospital bill.
• Co-payments and deductibles, which are the patient's liability but arrive as a shortfall against your bill.
• "Reasonable and customary" benchmarking, applied where you are not in that insurer's network.

Then there is the one that is entirely your own doing: gross discrepancy between the pre-authorisation and the final claim. TPA guidance lists it explicitly as a deduction trigger, alongside a warning that non-cooperation or misrepresentation in audited claims can lead to immediate delisting.

The direction of travel

The headline numbers have improved. In FY2024-25 insurers settled 3.26 crore claims, about 87 per cent by number against 83 per cent the year before, and repudiation fell to roughly 8 per cent. The amount paid rose to ₹94,248 crore.

Two figures cut the other way. Average payout per claim fell, from ₹31,086 to ₹28,910. And health insurance complaints have risen steadily: 47,658 in FY24, 64,365 in FY25, and 73,729 in FY26 up to February. At the Insurance Ombudsman, the share of health complaints resolved in the policyholder's favour dropped from 55 per cent to 41 per cent.

A rising settlement rate alongside a falling average payout is consistent with more claims being accepted and more of each being cut. It is not proof of it, and we have not seen the FY25 disallowed figure published anywhere reliable, so we are not going to assert it.

What this means for your hospital

Build the deduction register. One row per settled claim: billed, authorised, settled, deducted, and the head the TPA gave. Three months of that will tell you more about your revenue leak than any consultant will, including us.

Fix room-category discipline at admission, not at discharge. The proportionate deduction rule means the decision that costs you the money is made at the front desk by someone who does not know it is a financial decision.

Close the pre-authorisation gap. If your final bills routinely exceed the authorised amount, that is a clinical documentation and estimation problem, and it is producing deductions you will not win on appeal.

And use the 15-day window. Most TPA agreements give the hospital a fortnight from receipt of the settled amount to contest a deduction with documentary proof. Deductions that go uncontested become the baseline for the next negotiation.