The Insurance
Regulatory Authority of India (IRDAI) has reiterated its policy, and
issued a circular on Tuesday, aiming towards hospital authorities and
healthcare providers.
There have been numerous complaints that hospitals are not
allowing cashless claims offered by insurance companies.
Let’s understand this topic in detailed.
Hospitals Denying Cashless Claims
It has come to the insurance regulatory body, the Insurance Regulatory Authority of India
(IRDAI)’s notice that hospitals are not granting cashless facility for
treatment of Covid-19 despite such arrangements with the insurers.
It is also brought to the
notice of the Authority that some of these hospitals are also demanding cash
deposits from the policyholders.
IRDAI, on Tuesday, has
reported that according to 31 (d) of IRDAI (Health insurance) Regulations,
2016, general and health insurance companies are expected to enter into
agreements with enough number of public and private sector healthcare providers
across the geographical spread.
With private hospitals claiming their hands are tied, family
members have had to frantically arrange large sums of cash at short notice.
What is the New Circular Issued by IRDAI
In accordance to the current distress faced by patients and
policyholders due to hospitals defying cashless claims, IRDAI has issued a
circular.
It consists a series of instructions aimed at discouraging
healthcare providers from taking large sums of money as deposits from patients
and denying them cashless claims.
It also stated that in case a hospital denies the cashless
claim, policyholders are authorised to file a complaint to
the grievance redressal officer of
the insurer.
They can find the details regarding the same on the company’s
website.
What has IRDI Directed to its Policyholders?
Insurers have been told to put in place an exclusive
grievance redressal mechanism to address complaints relating to the denial of
cashless claims.
When a complaint is received
from a policyholder on denial of the cashless facility, IRDAI has asked the
insurance company to take an appropriate action against such hospitals.
Insurance companies have
also been directed by IRDAI to ensure the availability of cashless facility at
all the hospitals they have partnered with, as part of their insurance
offerings.
“Also, where policyholders’ interests are adversely affected because of the conduct of the network providers, such instances may be immediately reported to the appropriate Government agencies of the concerned State/area. Action taken against such network providers may also be published on the website of the insurance company for the information of the insured public,” it further added.
