[Becoming an Insurance Insider] Ophthalmology Brokers Running Rampant in Online Cafes

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[Asia Economy Reporter Oh Hyungil] "You can receive a free vision health checkup. Our cafe members, seize this great opportunity."

It has been revealed that famous domestic ophthalmology brokers are openly engaging in illegal solicitation activities in online cafes.

They introduce it by saying that they accompanied an acquaintance for eye surgery, paid only part of the hospital bill themselves, and the rest was covered by insurance, encouraging people to receive treatment without burden.

Mr. A, who was active in a fishing enthusiast cafe with an average age in the mid-50s and members up to 75 years old, went for eye surgery through an acquaintance and, after seeing the acquaintance receive a referral fee, received solicitation training after the ophthalmology surgery with the intention of marketing to cafe club members.

They induced checkups by offering free screenings to cafe members, but since the examinees were older, many were diagnosed with glaucoma or presbyopia. Ultimately, they pushed surgery unconditionally by saying that those with indemnity insurance only had to pay 10% of the surgery cost out-of-pocket.

In particular, under the pretense of special benefits, they performed surgeries without charging out-of-pocket costs and even arranged accommodations near the hospital for patients living in rural areas to check results the day after surgery, engaging in solicitation activities.

The insurance industry points out that excessive treatment caused by illegal sales practices of some ophthalmology clinics is the cause of indemnity insurance deficits.

Non-reimbursable medical expenses, which are not covered by health insurance due to cataract surgery, are rapidly increasing. The amount of insurance payments related to cataracts by 10 non-life insurance companies rose sharply from 249 billion KRW in 2018 to 425.5 billion KRW in 2019, and 637.4 billion KRW last year. In the first half of this year, it reached 481.3 billion KRW, a 58.2% increase compared to the first half of last year.

The loss from indemnity insurance for non-life insurers holding indemnity insurance contracts was recorded at 1.4128 trillion KRW in the first half of the year, a 17.9% increase from 1.1981 trillion KRW in the first half of last year. Adding life insurance companies, the insurance industry's estimated loss in the first half is expected to reach 1.7 trillion KRW.

A non-life insurance industry official said, "Since patients directly translate into money, the moral hazard of some hospitals and clinics that attract patients by dishonest means and profit is serious," and added, "Urgent control measures for non-reimbursable medical treatments must be established."