Can Hospitals deny for Cashless Treatment to the Policyholders?

If the enlisted network hospital who don’t grant or deny for such cashless treatment the person who is holding insurance policy, may send the complaint regarding the same to the concerned insurance company, there are certain network hospital who do not grant cashless facilities and insist the policyholder for cash payment, despite of the fact that policyholders are entitled to get cashless facilities under their insurance policy.

There are reports that some hospitals do not offer cashless treatment options and require cash payments from policyholders receiving Covid-19 treatment. IRDAI directed both independent and general health insurance companies to file complaints against such hospitals.

The regulator has directed the health insurance companies, to lodge complaints against such network hospitals, the insurer should make sure that excess charge should not be levied and also the denial of cashless facilities should not exist, insurer are also directed to by the regulator to ensure that cashless facilities should be available in every enlisted network provider.

For the cashless treatment, IRDAI (Insurance Regulatory and Development  Authority of India), had guided the insurer to ensure that policyholders must be charged as per rate agreed by the network provider, and also make sure that no extra charges are levied by the hospitals. Other than the rates on which they have agreed.

IRDAI has issued a clear order stating that network hospitals cannot reject non-cash insurance claims.All group hospitals that have benefited contracts with general and health insurance companies must provide cashless treatment to policyholders, including Covid-19 patients, according to the insurance agency.

IRDAI has urged disgruntled policyholders to file complaints with relevant insurance companies when network hospitals refuse cashless services to her Covid-19 patients.The reimbursement claim beneath the medical or health insurance policy must be settled  as per mentioned in the term and condition of the contract policy.

Consumers can lodge a complaint with the relevant insurance company. In addition, IRDAI’s website includes a list of insurance company complaints officer details and email IDs. At irdai.gov.in you have to click on the complaints and then Features.

How to File complain if denied for cashless treatment 

There are certain steps which a a policy holder should follow: 

Complaint to the concerned insurance company: If any such enlisted network hospital denies cashless facilities the policyholders have the concerned insurance company, the policyholder can complain about the insurance company’s official website.

If any policyholder does not get a response from the insurer, within the stipulated time or not satisfied with the response, the policyholder may approach the Grievance Redressal Cell of IRDAI, here the complaint has to submit the full details of the complaint which is required in the complaint registration form of the particular website

If the person is not satisfied, then a person can approach Igms.IRDAI.gov.in  and register themselves and login to the website and further can fill in the complete information regarding the complaint.

The person can also complain through e-mail the e-mail id on which a policyholder can complain is complaint@IRDA.gov.in  or can call on the helpline number that is 155255, 18004254732

Role of The Insurance expert

The insurance expert acts as a mediator and counsellor and provides equal and fair recommendations based on the facts. The complaint must be filed within one year of the rejection order given by the insurer, if the decision is finalised by the expert, the insurer has to comply with it within 30 days from the day of receipt and if the policy holder is not satisfied he can also approach the consumer court. 

How can Lead India help?

If any person is victimised by such malpractice our team of Lead India have an expert range of Legal Assistance who will assist you to get justice you desire, our team will help you in drafting and file complaints to consumer forum.