Insurance firms will have to decide on Covid claims within 60 minutes

In a major relief for policyholders, the Insurance Regulatory and Development Authority of India has directed insurers to decide on cashless Covid-19 treatment claims within 60 minutes of the receipt of the final bill.

The IRDAI directive came a day after the Delhi High Court told insurance companies that they cannot take several hours for approving bills of Covid-19 patients as it delays their discharge from hospitals and those in need of beds have to wait longer.

The court had warned insurance companies or third-party administrators (TPA) taking 6-7 hours to process insurance claims will face contempt of court action.

Here is what the IRDAI order says:

Insurers should communicate 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.

Both cashless preauthorization and final discharge of the insured patient should be done within a fixed turnaround time of two hours.

Decision on the final discharge of patients covered in Covid-19 claims shall be communicated to the network provider within one hour from the time of receipt of the final bill along with all necessary requirements from the hospital.