Covid 19: Relief for consumers as FM asks IRDAI to ensure cashless bill settlement at hospitals

Following reports of hospitals denying cashless claims, Finance Minister Nirmala Sitharaman on Thursday asked the Insurance Regulatory and Development Authority (IRDAI) to direct companies to prioritise authorisations and settlement of Covid cases. As of April 20, 2021, over 9 lakh covid related claims have been settled by insurance companies for Rs 8,642 crore, including tele-consultations.

Money9 earlier reported that many hospitals have started refusing cashless claims to patients leading to a rise in hospital bills. Dr Bhabatosh Mishra, Director- Claims, Underwriting & Product, Max Bupa Health Insurance had said: “We have got tariff agreement with network hospitals for cashless treatment of Covid-19. But we have seen that hospitals are pushing for claim settlement on reimbursement basis leading to rise in hospital bills.”

Insurance companies have tie-ups with hospitals for standard treatment rates in case of cashless treatment. During this second wave, it has come to notice that some hospitals are not accepting cashless payments, forcing policyholders to pay at the time of discharge, which they can claim later with an insurance company.

Two ways of making health insurance claims

Cashless basis: For a claim on a cashless basis, the treatment has to be done in a network hospital. For availing of the cashless facility, you need to get pre-authorisation for which you need to fill in the prescribed form. You might need to pay some advance deposit at the time of hospitalisation and KYC documents along with policy number. Here the insurance company directly pays to the insurer and you don’t have to wait for reimbursement. If the insurer denies you cashless service then you can later get the hospital bills reimbursed from your insurer.

Reimbursement basis: If you get treatment in a non-network hospital then you have to pay the bill and later make a claim from the insurance company.  There is generally a period of 7 to 15 days after the discharge during which you have to make a claim. After hospitalisation, ensure that you keep all documents such as claim form, discharge summary, prescriptions and bills ready that are needed for submitting a claim.