Health insurance: New rule for faster cashless approvals might get off to a slow start

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recently made it mandatory for medical insurance firms to authorise cashless hospitalisation within 1 hour of a request being made, and within 3 hours for a final approval at discharge. The new rules are to be implemented by 31 July.This, however, is unlikely to ease the plight of policyholders, say industry experts.For one, according to several experts Mint spoke with, hospitals spend much time in processing medical bills and sending them to insurers.“If there is a delay of 12 hours after the treating doctor gives a go-ahead for discharge, hospitals will have taken 8 hours and insurance companies the rest," said Dr. Prashant Mishra, a Mumbai-based cardiac surgeon.The other significant challenge arises when insurance companies seek additional information from hospitals.“The tariffs for many surgeries are fixed in packages.

But disputes arise on what is covered or not in the package. (Insurance firms) disallow certain billing and negotiate rates," said Dr. Anil Krishna, managing director of Hyderabad-based Mangrove Hospitals.“So far as cashless pre-approval is concerned, (insurers) tend to ask for a lot of documents to figure out if an insurance is valid or not.

For example, ascertaining if a patient is really a non-smoker and a non-alcoholic as he or she claimed," he added. “Medical care in India is subsidised but is still unaffordable for many. Finding an ideal solution is difficult."Dr.

S. Prakash, MD and CEO-designate at Galaxy Health and Allied Insurance, offered a counter. “Delays arise from both insurer-related issues and hospital-related issues, such as hospitals not adhering to all insurance provider requirements."There might, however, be a solution or two in the near future.The Union health ministry is holding