Mumbai:
The general insurers have asked the hospitals to comply with a few conditions in terms paperworks so that Covid-19 insurance claims or approvals for cashless treatment can be done speedily.
Earlier, the Delhi High Court had directed the insurance regulator IRDAI to advise insurers to communicate their cashless approvals to the hospitals/establishments within a maximum period of 30 to 60 minutes so that there will not be any delay in discharge of patients and hospital beds do not remain unoccupied.
In view of the directions by the Delhi High Court and the IRDA about the settlements covid claims in hour, the General Insurance Council, the representative body of 34 general insurers in the country, have laid down basic conditions for seeking the cooperation from hospitals for the faster settlement Covid-19 claims.
Over 15,00,000 claims, pertaining to Covid treatment alone have already been reported as on May begining and the numbers are only rising by the day.It it is decided to appeal to the hospitals’ administrations not only in Delhi but all over the country through this medium, to extend their cooperation to insurance companies on the following lines, said the GI Council.:
-To submit all the patient discharge documents in one go without having to remind for the missing documents viz. Cashless treatment approval reference, Copy of the case sheet,prescriptions, diagnostic reports, bills, discharge summary, Covid positive and the subsequent Covid Negative reports etc.
-To ensure billing done at pre-agreed rates and provide justification with supporting medical record for any co-morbidities necessarily treated.
– When the patient’s progress is good and discharge planned for the next day, hospitals may please inform the insurance company / TPA of the impending discharge the soonest and submit the available documents and bills. Balance documents and bills pertaining to the last 24 hrs. could be submitted at the discharge time so that the insurance company/TPA could also start working on the discharge simultaneously.
The insurance companies are ready to extend their maximum cooperation to hospitals in completing the discharge process in the quickest possible time in all cashless claims as per the HC directives and solicit the kind cooperation of all hospitals in this regard, said Atul Sahai, chairman of GI Council and CMD of New India Assurance, the largest general insurer in the country.
The large scale prevalence of Covid 19, as with the other organisations, has also adversely impacted the operations of insurance companies and the TPAs.Several of their employees and or their family members having been diagnosed Covid positive are either out of action or struggling to meet the demands of the situation. This, together with lock downs, lack of public transport etc. leading to thin attendance in offices,said the council.
Earlier, on the basis of Delhi High Court’s direction the Irdai asked all general and health insurance companies to communicate their decision on the authorisation of cashless treatment for Covid-related claims to network providers within an hour of receiving the request.
Also, they have to communicate their decision on the final discharge of patients, whose Covid claims are covered, within an hour of receiving the final bill from the hospital.
“Notwithstanding the above outer limits of timelines specified, the insurers are advised to process such requests promptly so that both authorisation for cashless treatment and discharge of the patient can be hastened to the maximum extent,” Irdai said in its circular..