Insurers will now have to approve cashless claims related to COVID-19 hospitalization within 60 minutes of receipt of required documents.
Insurance regulator IRDAI has directed insurers to inform hospitals about the authorization of cashless claims within one hour for COVID-19 cases. At present, insurers can take up to two hours to make a decision.
This decision has been taken after a Delhi High Court order directed the Insurance Regulatory and Development Authority of India (IRDAI) to ensure insurers make cashless decisions quickly.
A Delhi High Court order dated April 28 directed IRDAI to advise insurers to communicate their cashless approvals to hospitals within 30-60 minutes. This was to ensure that there is no delay in the discharge of patients and hospital beds do not remain unoccupied.
Cashless treatment refers to a feature in medical insurance policies where the customer is not required to pay any cash, and the bills are directly settled between the hospital and the insurer.
Decision on the final discharge of patients covered in COVID-19 claims also be communicated to the hospital within one hour of the receipt of the final bill.
had reported earlier that finance minister Nirmala Sitharaman has asked the Insurance Regulatory and Development Authority of India (IRDAI) to direct companies to prioritize COVID-19 claims.
Sitharaman had also said reports about some hospitals denying cashless insurance are being received.
As of April 20, there were 900,000 COVID-19 health claims worth Rs 8,642 crore settled by insurance companies. General insurers have received health insurance claims pertaining to Coronavirus treatment worth close to Rs 15,000 crore, according to the General Insurance Council data.
There has been a constant tussle between hospitals and insurers on COVID-19 hospitalization rates.
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Insurers rue that hospitals are not following the standard rates car issued in June 2020 by the General Insurance Council. Hospitals, on the other hand, have said all patients cannot be put under capped rates.
The government has capped rates for COVID-19 treatment in hospitals. But not all hospitals are following these rates and insurers want the pre-agreed terms to be followed.