For treatment of the deadly novel coronavirus infection, the insurance regulator IRDAI has asked insurance companies to have a communication channel with their network providers or hospitals such that customers grievance is addressed promptly.
And in a case when in these trying times you are denied a cashless treatment at hospitals, IRDAI asks you to write to the grievance cell of the concerned insurer. Details of the same are provided on the website. "It is clarified that the policyholders are entitled to cashless facility at all such network providers (hospitals) with whom the insurance company/TPA (third party administrator) has entered into an agreement in accordance to the norms of service level agreement (SLA)," IRDAI said in a circular.
Also, the regulator has asked insurers to put in place a special grievance cell for addressing complaints concerning denial of cashless claims. "Policyholders whose claims have been denied by hospital should immediately report the same to the appropriate government agencies in the state or area," it said.
This facility of cashless treatment does away with the need for the patient to settle hospital dues upfront and in fact it is the insurer who needs to settle the bill.