Complain about erring hospitals to govt: IRDAI to insurers

As India hit by a spontaneous wave of Covid-19 infections leading to an emergency like situation in hospitals across the country, the insurance regulator has asked insurance companies to report to state authorities if hospitals ask policy holders to pay cash in advance.

New Delhi:Amid reports of some hospitals charging high rates and insisting on cash from the policyholders for treating Covid-19, the insurance regulator IRDAI has asked insurers to report such irregularities to the concerned state authorities.

IRDAI also asked the insurers to put in place an effective communication channel with all the network providers for prompt resolution of grievances of policyholders.

“In order to ensure that all network providers extend cashless services to policyholders and to address any issues causing inconvenience to policyholders while availing cashless service, the Insurers are advised to put in place an effective communication channel with all the network providers for prompt resolution of grievances of policyholders,” the Insurance Regulatory and Development Authority (IRDAI) said in a circular on Friday.

The circular added: “Insurers are advised to report levying of excess charges or denial of cashless facility to the respective State Governments for appropriate action.”

IRDAI also said that demanding advance deposits from policy holders is a clear violation of service level agreement between hospitals and insurance companies.

“Charging differential rates to policyholders, demanding advance deposits and denying cashless treatment to policyholders of health insurance policies is not only detrimental to the interest of policyholders but may also violative of the service level agreement between the service provider hospitals and the insurance companies,” said the regulator.

In this difficult time of a second wave of COVID-19 pandemic, IRDAI said network provider hospitals are requested to "rise to the occasion" and to provide cashless treatment to policyholders for all treatments covered by the insurance policy including COVID-19.

Further, all insurers have been directed to ensure that the “reimbursement claims" under a health insurance policy should be settled expeditiously.

Finance Minister Nirmala Sitharaman on Thursday had asked the insurance regulator to “act immediately” to address the complaints of denial of cashless claims by insurance companies.

She had also mentioned that more than 9 lakh Covid related claims for Rs 8,642 crore have been settled by insurance companies as on April 20, 2021.

(With Agency Inputs)