facebook Approve cashless insurance claims within 60 minutes: IRDAI to insurers

Approve cashless insurance claims within 60 minutes: IRDAI to insurers

Cashless claims health insurance

Taking note of hospitals denying cashless facility to policyholders amid the rising covid-19 cases, insurance regulator IRDAI today asked insurers to approve cashless hospitalisation requests within 60 minutes of receipt of documents.

“Decision on authorization for cashless treatment for COVID-19 claims shall be communicated to the network provider (hospital) within a period of 60 minutes from the time of receipt of authorization request along with all necessary requirements from the hospital,” said the Insurance Regulatory and Development Authority of India (IRDAI) in a circular issued on Thursday.

It also said that the decision on final discharge of patients covered in Covid-19 claims will be communicated to the network provider within one hour from the time of receipt of the final bill along with the necessary requirements from the hospital.

In an earlier story, Moneymonc had reported that the delay in the cashless process had resulted in hospitals denying cashless request to customers. Previously, the time taken by insurers to approve cashless requests would vary from 2 hours to even longer in the pandemic with several insurance officials also falling ill with Covid infection.

Also Read: Rising COVID Claims: Hospitals refuse to extend cashless medical facilities

The delay in authorisation, hospitals claimed, were holding up the bed for the next incoming patient at a time when there is a severe shortage of beds due to rising cases of Covid-19.

The regulator also said that intermediaries such as Third Party Administrators must also comply with the timeline of facilitating cashless authorisation within 60 minutes.

In an earlier circular, IRDAI had said that insurers are advised to report levying of excess charges or denial of cashless facility to the respective State Governments for appropriate action.

Union finance minister Nirmala Sitharaman on April 22 tweeted about reports being received regarding some hospitals denying cashless insurance. To deal with this situation, the finance minister spoke to Insurance Regulatory and Development Authority of India (IRDAI) chairman SC Khuntia and asked him to take immediate action.

In March 2020, COVID-19 was included under the comprehensive health insurance plans. Cashless facility is available at networked or even temporary hospitals, she said.

As on April 20, a total of 900,000 COVID-19 health claims worth Rs 8,642 crore were settled by insurance companies. General insurers have received close to Rs 15,000 crore health insurance claims pertaining to the Coronavirus treatment.

Also Read: Covid-19: Health insurance helpline support list

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