Network hospitals can't deny cashless claims to COVID-19 patients: Finance Minister

After reports of hospitals denying cashless facility to the Covid-19 patients, insurance regulator IRDA has issued a circular to general and health insurers with regards to the health insurance claims.

The circular says if a health policy is eligible for a cashless claim, the insurer must ensure the settlement as per the agreement entered with the network hospitals.

The regulator said while reviewing cashless requests the insurers are also advised to ensure that the policyholders are charged as per the rates agreed to by network providers wherever applicable. "Insurers are also advised to ensure that hospitals do not levy any additional charges for the same treatment other than those rates that are agreed with the insurers," it says.

IRDA specifies insurers to report to the respective governments if a network hospital doesn't comply with the rules. In cases where reimbursement claims have to be settled, it has to be done as per the terms and conditions of the respective policy contract expeditiously. "Insurers are advised to issue suitable guidelines on this to all Third-Party Administrator (TPAs)," says IRDA. TPAs act as intermediaries between insurers and policyholders to process insurance claims.

The IRDA circular comes after Finance Minister Nirmala Sitharaman spoke to IRDA Chairman SC Khuntia to take immediate action on hospitals denying cashless settlement of bills.