Settle claims in 1 hr, ensure agreed rates: Insurers ask hospitals

With the Delhi High Court and insurance regulator Irdai directing insurance firms to complete settlement of Covid claims within an hour after discharge, the General Insurance Council — the representative body of 34 general insurers in the country — has laid down a basic framework for seeking cooperation from hospitals to implement the directives.

It has asked hospitals to submit all the patient discharge documents in one go without having to be reminded of the missing documents like cashless treatment approval reference, copy of case sheet, prescriptions, diagnostic reports, bills, discharge summary, Covid positive and subsequent Covid negative reports. They were also advised to ensure billing at pre-agreed rates and provide justification with supporting medical records for any co-morbidities necessarily treated.

According to the GI Council, when a patient’s progress is good and discharge is planned for the next day, hospitals should inform the insurance company or third party administrator (TPA) of the impending discharge the soonest and submit the available documents and bills. “Balance documents and bills pertaining to the last 24 hours could be submitted at the discharge time so that the insurance company or TPA could also start working on the discharge simultaneously,” it said.

Currently, insurers take up to five or six hours for settlement of hospital claims and patients are held up in the hospital during this period. Hospitals refuse to discharge patients without getting the insurer’s approval. “Insurance companies are ready to extend their maximum cooperation to hospitals in completing the discharge process in the quickest possible time in all cashless claims as per the HC directives and solicit the kind cooperation of all hospitals in this regard,” said Atul Sahai, Chairman of GI Council and CMD of New India Assurance, the largest general insurer in the country.

Earlier, the Insurance Regulatory and Development Authority of India (Irdai) had asked all general and health insurance companies to communicate their decision on the authorisation of cashless treatment for Covid-related claims to network providers within an hour of receiving the request. It also said they have to communicate their decision on the final discharge of patients, whose Covid claims are covered, within an hour of receiving the final bill from the hospital.

Over 15 lakh claims, pertaining to Covid treatment have been reported and the numbers are only rising by the day. “The large-scale prevalence of Covid-19, as with the other organisations, has also adversely impacted the operations of insurance companies and the TPAs. Several of their employees and or their family members having been diagnosed Covid positive are either out of action or struggling to meet the demands of the situation,” GI Council said.

Claims made under Covid health insurance have shot up to Rs 22,955 crore with 14.82 lakh customers submitting their hospital bills as on May 14, with the number of infections rising rapidly. While insurers have settled only claims of 12.33 lakh customers for about Rs 11,794 crore, they are yet to settle the claims of over 2.5 lakh customers and amount involving Rs 11,161 crore amid complaints about refusal by insurers to offer or renew health policies.

With Covid cases and claims shooting up, some insurance companies have been refusing to renew or offer new Corona health policies to customers, prompting the Irdai to come out with a directive not to deny Covid policy coverage to customers in the wake of rising infection rates. “The GI Council members were of the view that the cooperation from hospitals is paramount in achieving the noble objective behind the Court’s directive and IRDAI’s order and in being compliant thereof,” Sahai said.

Source: The Indian Express