The proposal is part of broader reforms in the insurance sector. This change is expected to simplify the change process and make the system more efficient
What could be good news for health insurance customers is that the centre is planning to ensure that cashless claims are processed even faster. While cashless clearance requests need to be approved within an hour, final claims need to be settled within three hours, according to a report by Livemint citing its exclusive sources.
Claims Need To Be Settled Within Three Hours
In fact, last month, the Insurance Regulatory and Development Authority of India (Irdai) had mandated the insurers to settle cashless claims in three hours.
Often, during discharge, the wait times are long. This means that the patient needs to stay for an extended period at the hospital, leading to a higher hospital bill. There have been instances when the insured have had to pay these expenses from their pocket even after having a comprehensive insurance policy.
The proposal is part of broader reforms in the insurance sector. This move could streamline the system, make it more efficient, and further simplify the change process.
Claim Rejections Also On The Rise
The average policyholder often faces claim rejections. Insurance Samadhan, a grievance redressal platform, said that around 88 per cent of complaints by policyholders are related to claim rejections.
During the year ended March 2024, the number of claims rejected and repudiated by insurance companies increased by 19.10 per cent to Rs 26,000 crore, as per a recent Irdai report.
There are several things a policyholder should do to avoid claim rejection. To prevent rejection claim, you must have your documents in place; you must not miss deadlines; you need to be aware of the waiting period and exclusion; fill out forms correctly, and stick to deadlines. You need to be proactive to speed up the claim approval process.
In fact, there have also been instances when private health insurers have been pulled up for rejecting claims. Recently, the district commission redressal commission acted against a private health insurance firm for rejecting the claim of a father and son.
Claims are rejected for several reasons. Not disclosing pre-existing health conditions is a valid reason to reject a claim. However, there have been instances when a claim was rejected on flimsy grounds, stating non-disclosure of pre-existing conditions.