Policy Comprehension and Procedures in Health Insurance Claim Submission

Abstrak

This paper explains why many people submit few health insurance claims even when coverage exists. Claim behavior is treated as a staged decision shaped by understanding of benefits, perceived process certainty, and experience with administrative demands during illness. Key causes include limited comprehension of policy terms, inconsistent guidance across service points, and procedures that require time, documents, and repeated verification. Negative expectations about acceptance, prior denial experiences, and unclear reasoning weaken trust and reduce willingness to initiate or continue claims. Non financial burdens matter, including stress, reduced attention while sick, and reluctance to engage in disputes with institutions. Social norms may label claiming as improper for minor costs, while privacy concerns can discourage disclosure through medical paperwork. Structural frictions arise when clinical workflows and claim workflows do not align, forcing patients to coordinate information manually. Limited administrative and digital skills, heavy work schedules, and family responsibilities further reduce follow through. The paper concludes that low claiming reflects combined cognitive, procedural, institutional, and social mechanisms that restrict practical access to contractual rights and shape choices toward direct payment and avoidance of administrative uncertainty.