Health Insurance: How cashless claims can be settled faster

financialexpress.com:

The insurance regulator has set a three-hour limit to settle cashless claims. Saikat Neogi identifies the bottlenecks in the health insurance claim settlement process and what hospitals and insurers need to do to speed it up.

What is the new timeline to settle cashless claims?

THE INSURANCE REGULATORY and Development Authority of India (Irdai) has directed health insurance companies to settle cashless health claims in three hours. The insurers will have to provide pre-authorisation for cashless requests to the policyholder via digital mode within an hour. If there is a delay in settling the claim by more than three hours, the additional amount charged by the hospital will have to be paid by the insurer from shareholders’ funds.
Insurers have to also ensure that hospitals release mortal remains immediately in the event of a death during treatment. In case the claim is repudiated or disallowed partially, details have to be given to the claimant with reference to the specific terms and conditions of the policy document. The new rules are to be implemented by July 31. Currently, after the treating doctor gives the approval for discharge, a hospital typically takes 6-8 hours to process the bills. It takes another 4-6 hours for the insurer to clear the bill, by which time another half-day’s charges are added to the final bill.

Why does this process take a long time?

CURRENTLY, THE COMPLEXITY of insurance products coupled with a lack of expertise among third-party administrators (TPAs) is the biggest roadblock in settling claims faster. TPAs only process the claim and escalate it to the insurance company for the final decision. Most often there is a delay in the exchange of information between the hospital and the insurance