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The Insurance Regulatory and Development Authority of India (IRDA) is preparing to introduce a new feature in health insurance policies. Under this policy holders will be able to get completely cashless treatment at any hospital. No hospital can refuse citing technical or other reasons. For this, IRDAI is preparing a proposal in collaboration with insurance companies, which is expected to be approved soon.
A network of hospitals will be ready: To facilitate the cashless process, IRDAI is in the process of creating a national network of hospitals across the country. For this, work is being done in collaboration with the Insurance Council. It is being said that, in the first phase, a centralized network will be created by the council, on which there will be an industry-level agreement between hospitals and all insurance companies. The members of the Council shall be part of this Agreement. The council has already constituted a committee to form a common panel of hospitals. Currently only 49 percent hospitals in the country provide cashless treatment facility. According to estimates, the number of such hospitals is around 25 thousand.
This will be beneficial: After the implementation of this initiative, every insurance company customer will have access to cashless hospital network and their claims will also be settled easily. This will be done by insurance industry representatives. This will greatly reduce costs and prevent any kind of fraud.
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Now this problem occurs: Currently many hospitals force the policy holder to deposit a certain amount during admission for treatment and that amount also has to be deposited. Additionally, most hospitals do not admit patients with cashless claims. At the same time, insurance companies deduct 10 percent or more from the total bill in the name of consumer and other items. Cashless claim cases are also pending. Presently the cashless claim settlement for most insurance companies is around 65% to 70%.
Disputes will also be resolved: Such cases have also come to light several times, with disputes between hospitals and insurance companies over claim settlements. IRDA’s new system will also remove such disputes.