Insurers meeting claim demands amid Covid

Mumbai INSURERS want hospitals to send all the documents, including co-morbidity related ones in one go so as to settle claims within one hour of discharge of the policyholders from the hospital.

General Insurance Council, the representative body of all the non-life insurers, stand alone health insurers, reinsurers and specialised insurers operating in India, met on May 2 and took stock of the situation arising out of the large number of Covid-19 claims besieging the health insurance industry.

Over 11,00,000 claims, pertaining to Covid treatment alone got reported as on May 2, and the numbers are only rising by the day. As on May 19, the reported claims touched 15.32 lakh in number.

The large-scale prevalence of Covid-19, as with the other organisations, has also severely impacted the operations of insurance companies and the TPAs. Several of their employees and or their family members having been diagnosed Covid positive, are either out of action or struggling to meet the demands of the situation. This, together with lockdowns, lack of public transport etc. are leading to thin attendance in offices. Work from home with the attendant limitations, is the order of the day. The Council and its member companies' CEOs have expressed satisfaction and full confidence in the abilities and resolve of their and the TPAs' employees who are rendering yeomen services despite several handicaps in these trying times. The members are quite sure that the employees of insurance sector also, along with the other Covid warriors, would continue to measure up to the occasion and would win kudos from all sections of the society.

"The Council and its member companies' CEOs have also examined the recent Delhi High Court's directions which were followed by an order from IRDAI dated 29 April, advising disposal of cashless claims from Hospitals within one hour of the receipt of final bills and other related documents. The Council and its members were appreciative of the circumstances in which the court had to issue such orders and the noble intent behind that and expressed their full commitment to implement the HC directives and the order of IRDAI," said GI Council chairman and New India Assurance CMD, Atul Sahai. The Council members were of the view that the cooperation from hospitals is paramount in achieving the noble objective behind the court's directive and IRDAI's order and in being compliant thereof, he added.

Therefore, the Council has appealed to the hospitals' administrations not only in Delhi but all over the country through this medium, to extend their cooperation to insurance companies by submitting all the patient discharge documents in one go without having to remind for the missing documents viz. cashless treatment approval reference, copy of the case sheet, prescriptions, diagnostic reports, bills, discharge summary, Covid positive and the subsequent Covid negative reports. Hospitals will have to ensure billing done at pre-agreed rates and provide justification with supporting medical record for any co-morbidities necessarily treated. When the patient's progress is good and discharge planned for the next day, an advance intimation from hospital to the insurance company/TPA of the impending discharge together with the available documents and bills helps the insurance company/TPA also start working on the discharge simultaneously. The insurance companies are ready to extend their maximum cooperation to hospitals in completing the discharge process in the quickest possible time in all cashless claims as per the HC directives and solicit the kind cooperation of all hospitals in this regard. Commenting on the development in an interaction with Bizz Buzz, GI Council Secretary General MN Sarma said, "GI Council members welcomed the court order and were appreciative of the background in which such an order had to be given by the court and the laudable intention behind that."

GI Council feels that the cooperation of Hospitals in the following ways as vital in complying with the court directive

• Submission of all claim documents in one go without having to remind
• Proper justification and treatment record of the co-morbidities, that necessarily have to be treated along with Covid treatment
• Billing at pre-agreed rates (where agreed mutually)