Claim Approvals to be Communicate

COVID-19 health insurance claim approvals to be communicate within 60 minutes: IRDAI

Claim Approvals to be Communicate the insurers process the claims promptly so that both authorization for cashless treatment.

Discharge of the patient can be hasten to the maximum extent.

Claim Approvals to be Communicate

 

The settlement of COVID-19 health insurance claims is expect to be quicker than before.

The IRDAI has issue norms to the insurance companies on settlement of COVID-19 health insurance claims.

All the general & health insurance companies are ask to communicate their cashless approvals to.

The concern hospitals and establishments within a maximum time period of 60 minutes.

The High Court of New Delhi in its 28.4.2021 Order had direct IRDAI to advise Insurers to.

Communicate their cashless approvals to the concern hospitals.

Establishments within a maximum time period of 30 to 60 minutes so that there shall not be any delay in discharge of patients & hospital beds do not remain unoccupied.

This move by the regulator comes as a great help to the policyholders when the number of Covid-19 cases are growing rapidly.

COVID relate claims were taking time to get settle which was delaying the discharge process of the patient.

However, with this new move of settling claims within one hour, by setting an outer limit.

The customers will give much relief and can deal with the Covid-19 expenses easily.

Though this move will surely put pressure on health insurers from operational perspective, however, it will be a boon for policyholders.

Claim Approvals to be Communicate

(IRDAI) on 18.4.2020 had issue

A note wherein a fixed turnaround time (TAT) of two hours for granting both cashless pre-authorization and for final discharge of the insured patient was specified.

In the wake of prevailing conditions of COVID-19 cases in the form of second wave and in line with

Aforesaid directions of the High Court, IRDAI has issue the following directions to all insurers:

a. Decision on authorization for cashless treatment for COVID-19 claims shall be communicate.

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.

b. Decision on final discharge of patients cover in COVID-19 claims shall be communicate.

The network provider within a period of one hour from the time of receipt of final bill along with all necessary requirements from the hospital.

The IRDAI has also ask insurers that notwithstanding the above outer limits of timelines specify.

They are advised to process such requests promptly so that both authorization for cashless treatment & discharge of the patient can be hastened to the maximum extent.

The Insurers will have to issue appropriate directions to their respective.

Third Party Administrators for ensuring compliance with the timelines specified above.

Cashless treatment for COVID-19

IRDAI had direct that policyholders can file a complaint against hospitals.

If they are not granting cashless facility for treatment of COVID-19 despite they being entitled for cashless facility under their policy.

Claim Approvals to be Communicate

In this regard, it is clarify that where insurers have an arrangement with the hospitals for providing cashless facility.

Such network hospitals are obligate to provide cashless treatment for all treatments including treatment for COVID-19.

All the network providers (hospitals) who have signed service level agreements (SLA) with general.

Health insurers have to mandatorily provide cashless facility for any treatment to the policyholders including COVID-19 treatment in accordance with agreed provisions of SLA and terms & conditions of policy contract.

 

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