Decide on cashless Covid treatment in an hour: Irdai to insurance firms | Business Standard News

Clipped from: https://www.business-standard.com/article/current-affairs/insurers-given-an-hour-to-inform-hospitals-of-cashless-nod-for-covid-claims-121042901124_1.html

Order follows a Delhi HC directive to the insurance regulator on this issue

The Insurance Regulator and Development Authority (Irdai) on Thursday 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. Also, 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. This follows the Delhi High Court’s direction to the insurance regulator to advise insurers to communicate their cashless approvals to the hospitals/establishments within a maximum 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. “Notwithstanding the above outer limits of timelines specified, the insurers are advised to process such requests promptly so that both authorisation for cashless treatment and discharge of the patient can be hastened to the maximum extent,” Irdai said in its circular. Earlier, the regulator had requested network providers (hospitals) to provide cashless treatment to policyholders for all treatments covered by the policy, including Covid-19, as per the terms of service level agreements. The regulator had also issued a communication to insurance companies that they should ensure all network provider hospitals extend the cashless facility for any treatment to the policyholder, including Covid-19 treatment, under agreed provisions. This move by the regulator came after there were reports that some hospitals were denying cashless facility to policyholders for treatment of Covid-19 treatment despite having a cashless arrangement with the insurers. Finance Minister Nirmala Sitharaman had tweeted last week asking the insurance regulator to act on the matter immediately. The regulator has also asked the general and health insurance companies to ensure that hospitals do not levy any additional charges for the same treatment other than those rates that are agreed with the insurers.

GUIDELINES FOR INSURERS

  • Insurance companies have to communicate decision on final discharge of patients covered in Covid claims in an hour
  • Earlier, the turnaround time for granting both cashless pre-authorisation and for final discharge was 2 hours
  • Delhi High Court had directed Irdai to issue advisory to insurers on this matter

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