Amid reports that some hospitals denying cashless facilities to patients, the Insurance Regulatory and Development Authority of India (IRDAI) has directed network hospitals to provide cashless treatment to insurers.
“Hospitals who have signed Service Level Agreement (SLA) with general and health insurers have to mandatorily provide cashless facility for any treatment to the policyholders including Covid-19 treatment in accordance with the agreed provision of SLA and terms and conditions of policy contract,” the Insurance Regulatory and Development Authority (IRDAI) said.
This IRDAI’s move comes in the backdrop of reports that some hospitals have refrained from providing cashless facilities for treatment of coronavirus patients despite policyholders being entitled to it. The insurance body issued a press release in this regard after Finance Minister Nirmala Sitharaman expressed concern about some hospitals denying cashless insurance to Covid-19 patients.
In the event of denial of the cashless facility at any such hospital, the policyholder may send a complaint to the concerned insurance company. It also mentioned that the details and email IDs of grievances redressal officers of insurance firms can be accessed from the IRDAI’s website (irdai.gov.in) by clicking on ‘Grievances’ and then on ‘functions’.
“As on 20/4/21, over 9 lakh Covid-related claims have been settled by insurance companies for 8642 Cr. Even teleconsultations can be covered. IRDAI shall direct companies to prioritise authorizations and settlements of Covid cases,” the finance minister added.
Confirming the IRDAI directives, the Ministry of Finance tweeted, “It is clarified by IRDAI that where insurers have an arrangement with the hospitals for providing cashless facility, such network hospitals are obligated to provide cashless treatment for all treatments including treatment for COVID-19.”
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Insurance companies have also been directed to ensure smooth availability of cashless facility with all the network providers (hospitals) empaneled with them by actively interacting with the hospitals.
