BackFM asks Irdai to act against insurers for denying claims
In last one month as the daily covid-19 case count reached the level of 3 lakhs per day, the insurance claims in parallel also have gone up manifold. The insurance companies claimed that they are though bearing monitory losses but settling the most genuine claims.
PremiumFinance minister Nirmala Sitharaman on Thursday told the Insurance Regulatory and Development Authority of India (Irdai) to speedily resolve the problem of covid-19 patients being denied cashless health insurance claims by hospitals and insurance companies.
“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," Sitharaman said in a tweet.
“As on 20/4/21, over 9 lakh Covid related claims have been settled by insurance companies for ₹8642 Cr. Even tele-consultations can be covered. IRDAI shall direct companies to prioritise authorisations and settlements of Covid cases," the finance minister said in another tweet.
In the last one month as the daily covid-19 case count rocketed, insurance claims went up manifold in parallel. Insurance companies claimed that they are making losses but settling the most “genuine" claims.
However, the public grievance cell of the government pertaining to health insurance claims has been receiving several complaints regarding denial of health insurance claims.
In response to the finance minister’s directive, Irdai in a press statement admitted reports of some hospitals not granting cashless facility for treatment of covid-19 despite policyholders being entitled for it.
“It is clarified that where insurers have an arrangement with the hospitals for providing cashless facility, such network hospitals are obligated to provide cashless treatment for all treatments including treatment for covid-19," the Irdai statement said.
In the event of denial of cashless facility at any such hospital the aggrieved policyholders may send a complaint to the insurance company, the Irdai said.
Insurance companies have also been directed to ensure smooth availability of cashless facility with all the hospitals empaneled with them. “The situation is worrisome and uncomfortable for the company. We are running into huge losses but we are still trying to settle maximum number of genuine claims coming from covid-19 patients," Dr S. Prakash, managing director, Star Health and Allied Insurance, told Mint.
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