Explained : Here is what you can do if hospitals deny cashless facilities for COVID treatment

Hyderabad: Waking up to reports that some hospitals are denying cashless facilities for the treatment of COVID 19, Insurance Regulatory and Development Authority of India (IRDAI) has asked Insurance Companies to take 'appropriate action' against these networks.

"It is clarified that where insurers have an arrangement with the hospitals for providing cashless facilities, such network hospitals are obligated to provide cashless treatment for all treatments including treatment for COVID-19. If any hospital network denies cashless facility and deviates from agreed terms of the Service Level Agreement (SLA), insurance companies shall take appropriate action against such network providers" said IRDAI.

Finance Minister Nirmala Sitharaman has also spoken to the chairman of IRDAI regarding the issue of denying cashless insurance. "Reports are being received of some hospitals denying cashless insurance. Spoken to Chairman, IRDAI Shri SC Khuntia to act immediately. In March'20 COVID included as a part of comprehensive health insurance. Cashless available at networked or even temporary hospitals," she said.

All the Network Providers (hospitals) who have signed Service Level Agreements (SLA) with general and health insurers have to mandatorily provide cashless facilities for any treatment to the policyholders including Covid-19 treatment in accordance with agreed provisions and terms and conditions of a policy contract.

All policyholders are entitled to the cashless facility at all such network providers (hospital) with whom the Insurance company/TPA has entered into an agreement shall avail the benefit of cashless treatment, said IRDAI.

In the event of denial of the cashless facility at any such enlisted network providers (hospitals) the aggrieved policyholders may send a complaint to the concerned insurance company. The details and email ids of Grievance redressal officers of insurance companies can be accessed from the website of the insurers or at the following link:

https://www.irdai.gov.in/ADMINCMS/cms/NormalData_Layout.aspx?page=PageNo225&mid=14.2

Insurance companies have also been directed to ensure smooth availability of cashless facilities with all the network providers (hospitals) empanelled with them by actively interacting with the hospitals.