Patients and their families availing health insurance will soon experience reduced delays in claim approval and payment. The government is set to implement major changes in the health insurance sector, requiring that cashless treatment approvals are made within one hour and final claim settlements within three hours for all insurance companies.
The aim of these proposed changes is to deliver swift and transparent services to policyholders, reducing the mental and financial burden often associated with medical treatment.
Part of a broader effort
This initiative is part of a broader effort to enhance transparency and accountability in the insurance system. The government is considering the introduction of operational standards similar to those of the Bureau of Indian Standards, which will not only facilitate quicker service but also address the rising instances of claim rejections.
Insurance companies have frequently rejected 100% cashless claims, causing big inconvenience for patients. To mitigate these issues, there are plans to enforce rules more stringently.
Streamlining and expediting insurance process
To streamline and expedite the insurance process, all hospitals will utilize standardized forms and application procedures, developed through a professional agency. This standardization aims to make the claims process smoother and more timely.
Process to be digitized
Besides, efforts are underway to digitize and increase the transparency of the insurance process through the National Health Claim Exchange, allowing both patients and hospitals to track claims in real time. The health authority and insurance regulator are collaboratively preparing new guidelines for this initiative.
Uniform rates and documentation
According to insurance experts, uniform rates and documentation for surgeries across the country could further accelerate the claims process. The rapid rise in insurance premiums underscores the necessity for these reforms.
At present, India has 26 general insurance companies, two specialized insurers, and seven independent health insurance companies, alongside approximately 200,000 hospitals. The average size of health insurance claims rose by 11.35% in 2023, reflecting increasing medical costs and inflation.
Prakash Kumar Pandey