Insurance Firms Ordered To Clear Cashless Claims Within 60 Minutes For Fast Discharge

The Insurers now need to approve cashless claims related to COVID hospitalisation within 60 mins of receipt of the required documents.

IRDAI has directed insurers to inform various hospitals about authorisation of cashless claims within an hour of COVID cases. Currently, insurers take up to two hours to make a decision.

This decision has been taken after Delhi High Court ordered IRDAI to ensure that insurers make cashless decisions quickly.

IRDAI Advised To Communicate Approvals Within An Hour

A Delhi HC order dated 28th April ordered IRDAI to advise insurers to communicate cashless approvals to hospitals within an hour. This was done to ensure no delay in discharge of patients and to ensure that hospital beds are not left unoccupied.

Cashless treatment usual refers to a feature in medical insurance policies where the customer isn’t required to pay cash, and the bills are directly settled between hospital and respective insurer.
Decision on the discharge of patients covered in COVID claims also need to be communicated to the hospital within an hour of the receipt of final bill.

Money control had earlier reported that the finance minister of India Nirmala Sitharaman has asked the IRDAI to direct companies to prioritise COVID claims.
Nirmala Sitharaman stated, reports of some hospitals denying cashless insurance are being received frequently.

As on April 20th, there were 9 lakh COVID health claims worth Rs 8642 crs settled by various insurance companies. General insurers lately have received numerous health insurance claims pertaining to Covid treatment worth around Rs 15000 crs, according to the General Insurance Council data.

Continous Tussle Between Hospitals & Insurers

There has been a continuous tussle between hospitals and insurers on the COVID hospitalisation rates.

Insurers argue that hospitals are not following the standard prescribed rate cards issued in June 2020 by the GIC. Hospitals, on the other end, state that all patients can’t be put under capped rates.
The government has already capped rates for COVID treatment in various hospitals. But not all the hospitals are following the prescribed rates and insurers are demanding to follow the pre-agreed terms.