InvestorQ : How long will the medical claim take to settle for the treatment of COVID-19?
Anjana Aiyar made post

How long will the medical claim take to settle for the treatment of COVID-19?

Answer
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Arya Nanda answered.
5 months ago


Recently, the insurance regulator IRDAI has directed insurers to comply with a certain timeline for settlement of dues, in order to ensure that all health claims are settled timely. While the pandemic continues to hit the nation, the cases are increasing severely. So, to ensure that the patients are given right and timely treatment IRDAI has issued such guidelines.

It mentioned that the decision on the authorization of cashless treatment of insured shall be communicated to the network provider (hospital) within two hours of receipt of authorization request by the insurer or to the TPA (Third Party Administrator) whichever is earlier and last necessary requirement by the hospital (if any).

Also, the decision on the final discharge shall be communicated to the network provider (hospital) within 2 hours of receipt of the last necessary requirements and the final bill from the hospital, either to the insurer or the TPA, whichever is earlier.
IRDAI also directed the insurers to issue appropriate and necessary guidelines to their TPAs.