Insurance regulatory changes are set to improve the cashless approval process for health insurance claims. However, industry experts warn that the new rules may require significant sectoral changes before patients can benefit from faster hospital discharge approvals.
The Insurance Regulatory and Development Authority of India (IRDAI) recently mandated that insurance companies must authorize cashless hospitalization within one hour of a request and provide final approval within three hours upon discharge. Despite these measures, experts believe that policyholders may still face challenges.
Hospitals are often blamed for delays in billing processing, which can lead to hold-ups in cashless approvals. Additionally, insurance companies may request extensive documentation to validate claims, which further delays the approval process. Disputes can also arise regarding package coverage and other claim details, further complicating the situation.
To address these issues, discussions are underway to launch a National Health Claim Exchange (NHCX), an online platform that would streamline information sharing among hospitals, insurers, and third-party administrators. By digitizing the claims process, the NHCX aims to expedite approvals and reduce processing times.
Moreover, advancements in insure-tech companies could play a key role in automating claims processing, potentially speeding up decision-making and reducing manual errors. Standardizing treatment costs and processes across hospitals could further expedite the claims process, benefiting policyholders.
Despite these initiatives, challenges remain in ensuring seamless cashless approvals for both planned and emergency hospitalizations. Coordination among multiple insurance policies and improved communication between insurers and policyholders are essential for a smoother claims experience.
In conclusion, while the new regulatory changes hold promise for faster cashless approvals, industry players must work together to address underlying challenges and streamline the claims process for the benefit of policyholders.
