Health insurers will have to convey their decision on requests raised for cashless treatment as well as on the final discharge or the amount that will be paid to the hospital within two hours.
This is the latest addition to the norms issued by Insurance Regulatory and Development Authority of India (IRDAI) on settlement of health insurance claims.
The two-hour window will apply to the decision on authorisation for cashless treatment. IRDAI wants insurers to “communicate the decision to the network provider (hospital) within two hours from the time of receipt of authorisation request and last necessary requirement from the hospital either to the insurer or to the Third Party Administrators (TPA), whichever is earlier.”
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Likewise, insurers will get two hours for deciding on final discharge. “The insurer should communicate to the network provider within two hours from the time of receipt of final bill and last necessary requirement from the hospital either to them or to the TPA, whichever is earlier,” the regulator said.
These directions are expected to cut down the waiting time, first for the insured in getting approval for cashless treatment, and second, in leaving the hospital after they are declared fit for discharge by the doctor.
The decision has been taken in view of the “prevailing conditions owing to COVID-19 as also taking into consideration the need for alleviating the pressure on the healthcare infrastructure,” IRDAI Member (Non-Life) T.L. Alamelu said in a circular.
Stating that IRDAI is keen on ensuring that all health insurance claims are responded to quickly, the circular said insurers are advised to issue appropriate guidelines to their respective TPAs.
