If the hospitals deny the policyholders of such a facility, the insured can send a formal complaint to the insurance company.
The Insurance Regulatory and Development Authority of India (Irdai) has reiterated that policyholders are entitled to avail cashless facility for Covid-19 treatment at hospitals which have entered into a service-level agreements with insurers and third-party administrators.
The regulator has also directed insurers to ensure availability of cashless facility at all the network providers (hospitals) empanelled with them.
It has asked insurers to take appropriate action against hospitals in case they deny cashless facility to policyholders and deviate from the agreed terms of the service level agreements. In cases, where the policyholder’s interests have been severely affected because of the hospitals, the regulator has asked the insurance companies
to report such hospitals to appropriate government agencies. If the hospitals deny the policyholders of such a facility, the insured can send a formal complaint to the insurance company.
are advised to put in place an exclusive grievance redressal mechanism to address the grievances of policyholders relating to the denial of cashless facility for Covid-19 and other grievances against such hospitals that are enlisted as network providers,” said Irdai.
Furthermore, insurers have to continuously engage with the hospitals that are in their network so as to resolve the grievances of the policyholders.