In a bid to help thousands of COVID-19 patients amid second wave of the pandemic, the regulator has asked the insurance companies to settle health insurance claims within an hour. This move came after Delhi High Court in its April 28 order, had directed the regulator to advise “insurers to communicate their cashless approvals to the concerned hospitals and establishments within a maximum time period of 30 to 60 minutes so that there shall not be any delay in discharge of patients and hospital beds do not remain unoccupied.”
The Insurance Regulatory and Development Authority of India (IRDAI) has released a detailed guideline for insurance companies on settlement of COVID-19 health insurance claims.
All you need to know:
1) In a circular to all general and health insurers, IRDAI has mentioned that the 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.
In April 2020, the regulator fixed a turnaround time (TAT) of two hours for granting both cashless pre-authorization and for final discharge of the insured patients.
2) The health insurance companies must communicate the decision on final discharge of patients covered in COVID-19 claims to 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, IRDAI noted.
“The insurers are advised to process such requests promptly so that both authorization for cashless treatment and discharge of the patient can be hastened to the maximum extent,” the regulator mentioned.
The regulator asked the insurers to direct the third-party administrators (TPAs) about this new timeline for smooth and hassle-free settlement of claims.
Cashless treatment for COVID-19
Earlier in April, IRDAI had directed 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.
“In this regard, it is clarified that where insurers have an arrangement with the hospitals for providing cashless facility, such network hospitals are obligated to provide cashless treatment for all treatments including treatment for COVID-19,” IRDAI said.
All the network providers (hospitals) who have signed service level agreements (SLA) with general and 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 and conditions of policy contract, the regulator mentioned.
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