Approvals for COVID-19 Health Claims within an Hour: IRDAI

The High Court of New Delhi in its recent order on 28th April 2021 stated to the Insurance Regulatory and Development Authority of India (IRDAI) to establish communication regarding cashless approvals to the concerned hospitals within a span of 30 to 60 minute.

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      All the health insurance companies in India have been told to fasten their claim process to speed up both cashless hospitalization and discharge patients from the hospital during the ongoing pandemic. The move is made amid the COVID-19 pandemic grim situation that has crippled the nation in just a few weeks. This move will ensure that the hospital beds do not remain vacant for long.

      The IRDAI has issued guidelines to the insurers that will ensure that the settlement of COVID-19 health insurance claims is done in a faster and better manner. All the health and general insurance companies have been asked to communicate within 1-hour regarding their cashless claims at the network hospitals.

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      It will be a great help to the policyholders amid the rapid increase of Covid-19 cases. It was being witnessed that certain Coronavirus-related health claims were taking longer and the discharge process was getting delayed. However, the new move of settling health claims within 60 minutes will give relief to the people and will help them manage Covid-19 expenses.

      The Insurance regulator issued a notice on 18.04.2020 wherein a fixed turnaround time of 2-hours was specified for both cashless treatment pre-authorization and hospital discharge of the policyholders.

      In the wake of the rising number of cases during the COVID-19 second wave and following the directions of the High Court, the following guidelines have been issued to all the health insurance companies:

      • The Health Insurance Companies and General Insurance Companies in India need to provide Cashless hospitalization authorization for coronavirus health insurance claims. The time limit is kept at maximum 60 minutes from the time of receiving the authorization request along with all the necessary documentation from the hospital.
      • Decision on patient’s final discharge from the hospital insured under COVID-19 health plans shall be communicated to the network hospital within 1 hour from the time of receiving the final bill along with all the necessary documentation from the hospital.

      The Insurance regulator has also asked the insurers that notwithstanding the above timelines specified; they are directed to promptly process such requests for both authorization for cashless hospitalization and discharge can be speeded to the maximum extent.

      Insurance providers will have to issue proper directions to their particular TPA’s for ensuring compliance with the above specified timelines.

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