Sanjeev Jain on LinkedIn: Health insurance: IRDAI sets 3-hour time limit for insurers to clear… (2024)

Sanjeev Jain

IRDAI,GM (Retd.) Telegram : irdaicircle

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In no case, the policyholder shall be made to wait to be discharged from the hospital," IRDAI said in a master circular dated May 29, 2024.The regulator further said: "If there is any delay beyond three hours, the additional amount if any charged by the hospital shall be borne by the insurer from shareholder’s fund."Hope this will be implemented in letter and spirit #irdai

Health insurance: IRDAI sets 3-hour time limit for insurers to clear cashlessclaims. Details here businesstoday.in

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Sanjeev Jain

IRDAI,GM (Retd.) Telegram : irdaicircle

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Implementation of this is impossible. Hospital give discharge summary only after they get approval from TPA. Hospital is not going to give complaint of TPA / Insurers. How to calculate the real discharge time from the hospital???? The audit / inspection need to be done of TPA. The time when the request from hospital received online and within how many hours the TPA has sent approval. The disclosure of the same need to be taken every month from TPA .

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Joseph Balaji

Educational Consultant and Trainer on General Insurance,Reinsurance and Risk Management subjects, Motivational speaker, Mock interview Panel member for IAS and other Services Training academies.

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Once Initial approval is given before the treatment could not understand the inordinate delay in giving the final approval. The patient and their family members face lot of stress due to the delay. It is hightime the Insurance companies and TPA's adhere to the timelines. If any issues are there they could take up later. The relationship between Hospitals and Insurance providers are not going to end with a single patient. Also most of the treatments are routine and repeated ones and where does deviation comes.

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LOKESH KUMAR

Worked with Care Health Insurance Ltd as a Manager Voice Operations CRM (live chat and email process)

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Great initiative by IRDAI and it should be strictly followed by the insurance companies and whichever insurance companies doesn't follow this timelines for cashless claim process their license should be cancelled because due to lon claim process by insurance companies many people lost their lives because they have not received treatment on time. In India only 2 % insurance companies process claims within TAT .

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