Six in 10 health insurance policy owners surveyed who had a claim in the last three years waited six to 48 hours for discharge, according to a survey by LocalCircles, a community platform, released on July 24.
To encourage better management of the patient discharge process, the Insurance Regulatory Development Authority of India (Irdai) has asked insurers and third-party administrators (TPAs) to complete cashless claims processing within one hour of receiving the final memorandum bill from the hospital. “This time frame is designed to enable quicker discharge of patients and reduce undue financial and emotional burdens on the policyholders, family members, and the general public. While this is not a penalty-based regulation, it nonetheless provides a strong motivation for insurers and hospitals to make the system faster and ensure accountability,” says Kunal Varma, CEO and Founder, Freo.
Why Delays Occur
Hospital delays in preparing and submitting the final bill and discharge summary to the insurer. Multiple layers of scrutiny by the TPA or insurer are common, especially with very large claims. Last-minute documentation issues, such as a missing report or unclear treatment details. In many cases, manual processes or a lack of coordination between the hospital and the insurer can contribute to delays, despite having digital systems in place. Even when claims are cashless, backend inefficiencies or non-standard hospital practices will often manifest in delays, even for cashless claims.
“While insurance companies pride themselves on processing claims within two hours of receiving the final documents, the claimant’s waiting period begins much earlier, from the moment the treating doctor gives the green signal. What follows is a series of internal hospital and administrative steps before the file even reaches the insurer,” says Surinder Bhagat, head, employee benefits, large account practices, Prudent Insurance Brokers. As a result, the overall wait time for the claimant can stretch far beyond what is reflected in the insurer’s metrics.
What To Do If Discharge Is Delayed
Request the hospital for an update. Ask if the final bill and everything required have been submitted to the insurer or TPA. Use the insurer/TPA helpline. There are usually escalation processes if processing takes an unreasonably long time.
“Further, use grievance redressal, if you feel the delay is unreasonable, consider a complaint through the insurer’s website or Irdai’s Integrated Grievance Management System (IGMS). Document everything. Keep all communication and billing records as evidence if there are any issues with the claim in the future,” says Varma.
Being proactive and keeping on top of things usually helps the process move faster.
