When selling insurance policies, companies make big promises and claims, but when it comes to claims, they start finding new excuses. This was revealed in a recent survey, which stated that about 42 percent of policyholders faced difficulties in getting claims after treatment, especially in health insurance cases. The figure of 42 percent is quite high, and taking this seriously, the insurance regulator IRDAI has tightened the screws on companies.

IRDAI has issued a master plan and told insurance companies in no uncertain terms that there should be no delay in this work, and the facility should be implemented by July 31 under all circumstances. It is believed that from August 1, 2024, all health insurance policyholders will start benefiting from this. Cashless claim means that the insurance company will bear the entire cost of treatment, as stated in the policy terms. Currently, in many cases, companies ask for reimbursement later, which causes unnecessary paperwork for policyholders and delays in claims.

Every hospital will have a help desk for health insurance holders

Insurance regulator IRDAI has instructed companies to set up a physical help desk in all hospitals within their circles, providing immediate assistance to policyholders. The regulator states that now all companies will have to offer 100% cashless claims. The entire process must be completed within 3 hours. If it takes longer and the hospital levies an extra charge, the insurance company will have to reimburse it

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Approval Before Treatment Begins

IRDAI has stated in its master circular that insurance companies will pre-authorize all insurance holders. They have been given a time of 1 hour for this. This means as soon as someone reaches the hospital for treatment, the hospital sends a draft to the insurance company estimating the cost of the policyholder’s treatment. The hospital will inquire whether the insurance company is ready to cover the cost of the person’s treatment

Discharge Time Also Specified

IRDAI has instructed companies in two clear points that insurance companies cannot delay discharge from hospitals due to money. Companies must provide final approval for discharge within 3 hours. If a policyholder dies, the insurance company must settle the claim immediately, and the hospital cannot detain the body.

According to Bhaskar Nerurkar, Head of Health Administration Team at Bajaj Allianz, the major health insurance provider, most companies already make pre-authorization available within 30 minutes to 1 hour. He believes that IRDA’s step will benefit both insurance companies and policyholders, helping to avoid unnecessary disputes. He also advises consumers to provide all necessary documents promptly for quick claim settlement, which would facilitate the process for the company as well.

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