Network hospitals can't deny cashless claims to Covid-19 patients: IRDAI

NEW DELHI:  The Insurance Regulatory and Development Authority of India (IRDAI) has clarified that network hospitals have to facilitate cashless insurance claims of Covid-19 patients where insurers have a prior arrangement. The regulator has also directed insurance companies to take ‘appropriate action’ against network hospitals denying cashless service for any treatments, including treatment for Covid-19. 

This clarification comes in the backdrop of reports that some private hospitals are not granting cashless facilities for treatment of Covid-19 and instead insisting on cash payments despite policyholders being entitled for the cashless treatment under the policy.

Taking a stern view of the matter, Finance Minister Nirmala Sitharaman had earlier held talks with IRDAI chairman SC Khuntia on the problems some have faced and the need to address it. Sitharaman had earlier tweeted, "Reports are being received of some hospitals denying cashless insurance. Spoken to chairman, IRDAI Shri SC Khuntia to act immediately. In March’20 #Covid included as a part of comprehensive health insurance. Cashless available at networked or even temporary hospitals."

All the Network Providers (hospitals) who have signed Service Level Agreements (SLA) with general and health insurers have to mandatorily provide cashless facilities for any treatment to the policyholders including Covid-19 treatment in accordance with agreed provisions of SLA and terms and conditions of policy contract.

In the event of denial of cashless facility, the aggrieved policyholders may send a complaint to the concerned insurer. The details and email ids of grievance redressal officers of insurance companies can be accessed from the website of the companies.