In a move to address the policyholders’ concerns, the Consumer Affairs Ministry will discuss the re-evaluation of the 24-hour hospitalisation rule required for a mediclaim. In response to the concerns raised by Justice Amreshwar Pratap Sahi, the Consumer Affairs Ministry has said that it will take up the issues that arise because of the 24-hour hospitalisation mandate with the IRDAI and DFS.
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For health insurance claims to go through, a minimum of 24-hour hospitalisation is necessary. Most insurance companies don’t accept a claim if the policyholder has not been admitted to a hospital for at least 24 hours for a surgical procedure. Highlighting the evolving medical treatments and advanced surgical procedures, the National Consumer Disputes Redressal Commission president aims to discuss the matter with IRDAI (Insurance Regulatory and Development Authority of India) and DFS (Department of Financial Services) to make insurance companies aware of the associated issues. This rule often comes up in cases of medical claims and medical negligence-related disputes.
While a few district forums have innovated and instructed that claims be paid for hospitalisations of 23 and a half hour, a viable solution is still required. Along with the DFS and IRDAI, reforms must be made to make the claim process more consumer-friendly and reduce claim disputes arising from the 24-hour hospitalisation rule.
With improved technology and advanced procedures, a lot of complex surgeries and treatments can be done in less than 24 hours. However, due to the minimum 24-hour hospitalisation rule, such claims are generally rejected, and the financial burden falls on the policyholder. Several cases have also been where some insurance claims have been wrongfully rejected based on this rule. Justice Sahi also emphasised the need for a standardised procedure to improve consumer justice.
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