IRDAI directs insurers to decide on COVID-19 claims within 60 minutes

NEW DELHI: Regulator IRDAI on Thursday directed insurers to decide on cashless COVID-19 treatment claims within 60 minutes of the receipt of final bill so that the hospital bed can be quickly made available to another waiting patient.

The Insurance Regulatory and Development Authority of India (IRDAI) also directed all general and health insurers to communicate their decision on authorisation for cashless treatment for COVID-19 claims to the hospital within 60 minutes from the time of receipt of request along with all necessary requirements from the hospital.

The regulator issued this direction in view of a Delhi High Court order asking the regulator to tell insurers to communicate their cashless approvals within a maximum time period of 30 to 60 minutes so that there is no delay in discharge of patients.

In the wake of the second wave of COVID-19 and in line with directions of the High Court, IRDAI directed insurers that "decision on final discharge of patients covered in COVID-19 claims shall be communicated to the network provider within a period of ONE hour from the time of receipt of final bill along with all necessary requirements from the hospital".

In an order dated April 28, 2021, the Delhi High Court had directed IRDAI to advise insurers to communicate their cashless approvals to the concerned hospitals/establishments within a maximum time period of 30 to 60 minutes so that there shall not be any delay in discharge of patients and hospital beds do not remain unoccupied.

The IRDAI's circular further said notwithstanding the 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.

The insurers have also been asked to issue appropriate directions to their respective Third Party Administrators (TPAs) for ensuring compliance with the timelines.