The regulator noted that there are reports of certain network providers (hospitals) charging high rates and insisting on cash payments from the policyholders for providing treatment to COVID-19 infected patients despite having cashless arrangement with insurers.
“In compliance with the provisions…the insurers, in case of ‘cashless claim’ under a health insurance policy, are advised to ensure expeditious settlement of such claims on cashless basis in accordance to the Service Level Agreements (SLAs) entered with hospitals,” it said in a circular.
Insurers have also been asked to ensure that the policyholders are charged as per the rates agreed to by network providers wherever applicable.
“Insurers are also advised to ensure that hospitals do not levy any additional charges for the same treatment other than those rates that are agreed with the insurers,” the circular said.
Meanwhile, in a separate statement, IRDAI also said 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.
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.
“All hospitals are also requested not to differentiate the patients in terms of admission or treatment whether they are insured or not insured or whether they pay cash or avail of cashless facility.
“A gesture of this nature on the part of hospitals in these difficult times will re-inforce the confidence of the public in the healthcare system including health insurance and build trust,” the statement said.
IRDAI’s circular also asked the insurers to put in place an effective communication channel with all the network providers for prompt resolution of grievances of policyholders.
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.