Indah Kurnia: Don’t Let Differences in BPJS and Hospital Claims Jeopardize Patient Safety

PARLEMENTARIA, Semarang — Deputy Chair of the DPR RI House Affairs Agency (BURT), Indah Kurnia, said delays in BPJS Kesehatan claim payments to hospitals should be addressed through ongoing communication and education among hospitals, BPJS Kesehatan, and patients. All three parties need a shared understanding of medical emergency criteria, coverage mechanisms, and claim payment procedures.

Indah made the remarks after the DPR RI BURT’s specific working visit to St. Elisabeth Hospital in Semarang, Central Java, on Friday (13/11/2026). She said differences in the medical emergency criteria applied by hospitals, BPJS Kesehatan, and patients could be one source of problems in the claim submission process.

Indah gave the example of situations in which hospitals must provide medical treatment even though a patient’s condition does not meet the criteria for coverage by BPJS Kesehatan. She cited a patient with a temperature of 39 degrees Celsius who was already in unbearable distress, while certain coverage provisions require a temperature of 40 degrees Celsius.

“If a patient is already screaming that they can’t take it, the hospital has no choice but to admit them. When it does—for example, with a fever of 39 degrees—if the temperature is not 40 degrees, it isn’t covered, so the treatment costs are not reimbursed. Yet the hospital still provides care and treatment to the patient,” Indah said.

According to the PDI-P faction politician, this situation can cause problems in submitting and settling hospitals’ bills or invoice claims to BPJS Kesehatan. As a result, hospitals may bear a financial burden when they have provided care but their submitted claims have yet to be settled.

Indah also said that issues related to health service coverage are frequently raised with her at various meetings of Commission IX of the DPR RI with health-sector stakeholders. One issue that has come to the fore is the practice of asking patients to go home after three days of treatment.

“Being sent home after three days has practically become a familiar phrase. We still need to address this, and medical staff on the ground, patients, and BPJS itself need to be better informed. All three parties need to receive education so they understand,” she stressed.

She explained that differing understandings of coverage mechanisms can affect care decisions. Hospitals, for example, may worry that BPJS will not cover treatment costs if a patient remains hospitalized for longer. Patients, meanwhile, need to be informed about coverage provisions and the medical considerations behind treatment decisions.

Therefore, Indah called for more intensive communication between hospitals and BPJS Kesehatan to clarify information circulating on the issue. She said the belief that patients must be sent home after three days because hospitals fear they will not be paid needs to be clarified jointly.

“If we ask BPJS, that’s actually not the case. So we need to sit down together regularly. Hopefully things will improve in the future,” concluded the legislator for East Java I electoral district.

BPJS Claim Payment Provisions

For context, the mechanism for BPJS Kesehatan to pay hospital claims is governed by Presidential Regulation (Perpres) Number 82 of 2018 on Health Insurance. Under Article 76, claims to Advanced-Level Referral Health Facilities (FKRTL) must be paid no later than 15 days after the record confirming the completeness of the claim documents is issued and the claim is verified.

The provisions also set a time limit for cases in which the record confirming the completeness of the claim documents is not issued within the specified period. Meanwhile, according to BPJS Kesehatan, the average time to pay hospital claims throughout 2025 was around 13.6 calendar days from the date the documents were declared complete.

That figure is below the maximum payment time limit set out in the regulations. Nevertheless, Indah hopes communication between hospitals and BPJS Kesehatan will continue to be strengthened so that differences in understanding and administrative issues with coverage do not impede care or harm patients. (we/um)