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Some families of COVID-19 patients were allegedly forced to opt for cash payment despite having cashless insurance policies.

A person sitting with their hands on their head and elbows on table, bills strewn on table
Money Wednesday, April 28, 2021 - 14:47

The Insurance Regulatory and Development Authority (IRDA) on Tuesday urged hospitals not to discriminate between patients having cash and cashless policies while treating COVID-19 cases. Cashless facility means direct settlement of hospital bills by the insurers.

It also asked insurers to see to it that cashless services are available for COVID-19 patients who are insured.

The IRDA missive comes amid reports that some families of COVID-19 patients were allegedly forced to opt for cash payment for settling hospital bills despite having cashless insurance policies.

"We have requested the hospitals not to discriminate between cash and cashless patients. We have written to the insurers as well, urging them to make sure that the agreement between the companies and hospitals is honoured. I am sure these difficulties will be addressed,” IRDA Member (Life), K Ganesh, said, during a virtual interactive session with the Merchants' Chamber of Commerce.

An official of a Kolkata hospital said some of the issues regarding insurance claims of COVID-19 patients have come up due to shortage of staff amid the pandemic, and delay in receiving the settlement amount.

Last week, the regulator directed general and health insurance companies to take action against hospitals if they don't provide cashless facility for COVID-19 claims.

In a circular, the Insurance Regulatory and Development Authority of India (IRDAI) told the insurers to take appropriate action against hospitals denying the cashless facility as per their agreement. 

The IRDAI said that general and health insurers shall ensure that all network provider hospitals extend the cashless facility for any treatment to the policyholder, including for COVID-19 treatment in accordance with agreed provisions of Service Level Agreement and terms and conditions of the policy contract.

If cashless facility is denied at enlisted hospitals, the IRDAI said that the policyholder can complain to the insurance company’s grievance officer. 

“Insurers have also been directed to ensure smooth availability of cashless facility with all network providers empanelled with them by putting in place continuous communication channel with all the network providers for prompt cashless services and for resolution of grievances of policyholders if any,” it said in its circular to insurers. 

With inputs from PTI

 
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