Insurers must tell hospitals about cleared claims in 1 hour

HYDERABAD: Insurance Regulator and Development Authority of India (Irdai) has told insurers to communicate their cashless approvals for Covid-19 claims within an hour of submission of the request by the hospital and ensure that patients get discharged soon.

In its order on April 28, the Delhi HC had told Irdai to issue immediate instructions to insurance companies to ensure that they communicate their approvals to hospitals within 30 to 60 minutes, in order to ensure that patient discharge is not delayed.

“Decision on authorisation 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 authorisation request along with all necessary requirements from the hospital,” Irdai said in its latest circular on Thursday.

It further advised insurers to process such requests promptly so that both the authorisation for cashless treatment and discharge of the patient is speeded up. “Decision on final discharge of patients covered in Covid-19 claims shall be communicated to the network provider within a period of one hour from the time of receipt of the final bill along with all necessary requirements from the hospital,” it said.

Earlier, a turnaround time (TAT) of two hours for granting both cashless pre-authorization and final discharge of the insured patient was specified by the regulator. The fast-tracking of Covid-19 health claims process comes in the wake of multiple reports of Covid-19 patients being denied cashless services by hospitals despite having proper insurance covers.

While Irdai has issued guidelines directing policyholders to inform their insurance companies promptly about such anomalies, it has said that insurers can lodge complaints about errant hospitals with the respective state governments.

Source: The Times of India