Report errant hospitals to State govts: IRDAI tells insurers

The Insurance Regulatory and Development Authority of India (IRDAI) has advised insurers to report hospitals levying excess charges or denying cashless facility to respective State governments for appropriate action.

Citing reports, including those of some hospitals charging differential rates, the regulator asked insurers, dealing in health insurance, to ensure policyholders are charged as per rates agreed upon by the network providers (hospitals). They should also ensure hospitals do not levy any additional charges for the same treatment other than that agreed.

“Charging differential rates, demanding advance deposits and denying cashless treatment is not only detrimental to the interest of policyholders, but may also [be] violative of the service level agreement (SLA) between the service provider hospitals and the insurance companies,” the regulator said in a press release on Friday.

Requesting network provider hospitals to “rise to the occasion and provide cashless treatment to policyholders for all treatments covered by the policy, including COVID-19” as per the SLA terms, IRDAI urged hospitals to refrain from differentiating patients in terms of admission or treatment, whether they are insured or not or whether they pay cash or avail cashless facility.

“A gesture of this nature on the part of hospitals in these difficult times will reinforce the confidence of the public in the healthcare system, including health insurance and build trust,” the release said.

In a circular to the insurers, IRDAI advised them to ensure expeditious settlement of cashless claim in accordance with the SLAs with the hospitals. While doing so, insurers should ensure policyholders are charged as per agreed rates, by the hospitals, and not levied any additional charges for the same treatment. It wanted insurers to have in place an effective communication channel with the hospitals for prompt resolution of grievances of policyholders.

The latest advisory follows the one on Thursday that IRDAI issued after Union Finance Minister Nirmala Sitharaman tweeted that she had spoken to IRDAI chairman following reports of some hospitals denying cashless insurance.

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