According to the financial industry on the 14th, insurers have recently faced a string of disputes over whether hospitalization was necessary for nerve plasty patients. According to insurer A, a 55-year-old woman surnamed Kim underwent nerve plasty in June this year, was hospitalized and claimed 1.98 million won in indemnity insurance benefits. But the insurer determined hospitalization was unnecessary because her condition had improved and there were no complications, and paid only 200,000 won in outpatient medical expenses. For nerve plasty, inpatient treatment currently costs 2 million won per session, while outpatient treatment costs 200,000 won.
Nerve plasty is a treatment in which a thin catheter is inserted into the spinal nerve area to remove inflammation and swelling that cause pain. At the heart of the disputes is the wide coverage gap between outpatient and inpatient treatment. The indemnity coverage limit for outpatient care is typically 200,000 to 300,000 won, but hospitalization is covered up to 50 million won a year depending on the policy. The average non-covered price also reaches 1.8 million won. The insurance industry points out that although patients could first be treated with nerve block procedures and other methods covered by national health insurance, indemnity coverage is encouraging expensive nerve plasty and unnecessary hospitalization. Last year, disputes related to nerve plasty accounted for about 20% of all indemnity insurance disputes.
In December last year, the government designated nerve plasty as a managed benefit item, along with manual therapy and radiation hyperthermia treatment. Managed benefits are a system under which the government sets prices, indications and treatment frequency to curb excessive treatment. But only manual therapy took effect in July this year, while the introduction of measures for nerve plasty and hyperthermia treatment has been delayed amid opposition from the medical community.
An insurance industry official said, "The longer prices and treatment standards remain absent, the longer excessive treatment and indemnity disputes will continue," adding, "The application of managed benefits must be expedited."
