{"id":1720,"date":"2022-09-14T12:01:17","date_gmt":"2022-09-14T06:31:17","guid":{"rendered":"https:\/\/www.leadindia.law\/blog\/en\/?p=1720"},"modified":"2022-12-24T18:28:25","modified_gmt":"2022-12-24T12:58:25","slug":"cashless-facility-cannot-be-denied-by-the-hospitals","status":"publish","type":"post","link":"https:\/\/www.leadindia.law\/blog\/en\/cashless-facility-cannot-be-denied-by-the-hospitals\/","title":{"rendered":"When Cashless claims can be denied by the Hospitals"},"content":{"rendered":"\n<p>The Insurance Regulatory and Development Authority of India have observed that recently many hospitals are denying the cashless treatment facility to the policyholders. According to section 31 (d) of IRDAI, insurance companies shall have an agreement with private and public healthcare institutions. The list of network hospitals shall be published along with the policy document. Policy terms shall clearly specify that IRDAI shall direct Insurance Companies to deliver smooth cashless treatment to policyholders.<\/p>\n\n\n\n<figure class=\"wp-block-embed is-type-video is-provider-youtube wp-block-embed-youtube wp-embed-aspect-16-9 wp-has-aspect-ratio\"><div class=\"wp-block-embed__wrapper\">\n<div class=\"ast-oembed-container\"><iframe title=\"How To Complain Against Hospital | What If Hospital Deny For Cashless Treatment\" width=\"500\" height=\"281\" data-src=\"https:\/\/www.youtube.com\/embed\/o80UMyreAcw?feature=oembed\" frameborder=\"0\" allow=\"accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share\" referrerpolicy=\"strict-origin-when-cross-origin\" allowfullscreen src=\"data:image\/svg+xml;base64,PHN2ZyB3aWR0aD0iMSIgaGVpZ2h0PSIxIiB4bWxucz0iaHR0cDovL3d3dy53My5vcmcvMjAwMC9zdmciPjwvc3ZnPg==\" class=\"lazyload\" data-load-mode=\"1\"><\/iframe><\/div>\n<\/div><\/figure>\n\n\n\n<h3 class=\"wp-block-heading\">Know Your Claims:<\/h3>\n\n\n\n<p>On the basis of network and non-network hospitals claims can be divided as reimbursement and cashless. In cashless claims insured shall not pay the bills. However, in reimbursement scenarios, policyholders shall pay in cash at first instance and later can be recovered by reimbursement from the hospital. In Agreement there shall always be a list of empanelled and non empanelled hospitals.<\/p>\n\n\n\n<div class=\"wp-block-media-text alignfull has-media-on-the-right is-stacked-on-mobile has-background\" style=\"background-color:#cbcbcb\"><div class=\"wp-block-media-text__content\">\n<h3 class=\"wp-block-heading has-text-align-center has-text-color\" style=\"color:#000000\"><strong>Need A Legal Advice<\/strong><\/h3>\n\n\n\n<p class=\"has-text-align-center has-extra-small-font-size\">The internet is not a lawyer and neither are you. Talk to a real lawyer about your legal issue<\/p>\n\n\n\n<div class=\"wp-block-buttons is-content-justification-center is-layout-flex wp-container-core-buttons-is-layout-16018d1d wp-block-buttons-is-layout-flex\">\n<div class=\"wp-block-button\"><a class=\"wp-block-button__link wp-element-button\" href=\"https:\/\/www.leadindia.law\/talk-to-lawyer\" target=\"_blank\" rel=\"noreferrer noopener\">Talk to a Lawyer<\/a><\/div>\n<\/div>\n<\/div><figure class=\"wp-block-media-text__media\"><a href=\"https:\/\/www.leadindia.law\/talk-to-lawyer\"><img decoding=\"async\" width=\"400\" height=\"200\" data-src=\"https:\/\/www.leadindia.law\/blog\/en\/wp-content\/uploads\/2022\/09\/talk-to-lawyer-black-logo.png\" alt=\"\" class=\"wp-image-1667 size-full lazyload\" data-srcset=\"https:\/\/www.leadindia.law\/blog\/en\/wp-content\/uploads\/2022\/09\/talk-to-lawyer-black-logo.png 400w, https:\/\/www.leadindia.law\/blog\/en\/wp-content\/uploads\/2022\/09\/talk-to-lawyer-black-logo-300x150.png 300w\" data-sizes=\"(max-width: 400px) 100vw, 400px\" src=\"data:image\/svg+xml;base64,PHN2ZyB3aWR0aD0iMSIgaGVpZ2h0PSIxIiB4bWxucz0iaHR0cDovL3d3dy53My5vcmcvMjAwMC9zdmciPjwvc3ZnPg==\" style=\"--smush-placeholder-width: 400px; --smush-placeholder-aspect-ratio: 400\/200;\" \/><\/a><\/figure><\/div>\n\n\n\n<div style=\"height:25px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<h3 class=\"wp-block-heading\">When Cashless Claims Can Be Denied?&nbsp;<\/h3>\n\n\n\n<p>Even a cashless facility can be denied in a <a href=\"https:\/\/www.leadindia.law\/ask-free-question\">network hospital to a policyholder <\/a>, if the information sent by the hospital is insufficient or in case the ailment is not covered under the policy or the request of pre-authorization is not sent in time.\u00a0<\/p>\n\n\n\n<p>However, if the cash facility is denied one can subsequently on discharge from hospital submit a claim for reimbursement.<\/p>\n\n\n\n<p>Hospitalisation can either be planned or a medical emergency. Under any of these circumstances the insurer shall be intimated immediately upon <a href=\"https:\/\/www.leadindia.law\/talk-to-lawyer\">hospitalisation\u00a0by submitting a pre authorization form.<\/a><\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Direction of IRDAI:<\/h3>\n\n\n\n<p>The Insurance Regulatory and Development Authority of India issued a circular which aimed at discouraging healthcare providers from taking large amounts of money as deposits from patients and denying them cashless claims.<\/p>\n\n\n\n<p>The circular says, \u201cIt is clarified that the policyholders are entitled to the cashless facility at all such network providers (hospitals) with whom the <a href=\"https:\/\/www.leadindia.law\/free-legal-advice\">insurance company\/TPA (third party administrator)<\/a> has entered into an agreement in accordance with the norms of service level agreement (SLA).\u201d<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Redressal:<\/h3>\n\n\n\n<p>Policyholders can file a complaint by writing to the grievance redressal officer of the insurer details of which will be mentioned on the respective website of the insurer.<\/p>\n\n\n\n<p>Insurers have been asked to put in place exclusive grievance redressal mechanisms and policies to address complaints relating to the denial of cashless claims.<\/p>\n\n\n\n<p>Therefore, it is clear that policyholders can avail cashless facility in all network provider\u2019s or hospitals that are registered with the insurer as per terms of Service Level Agreement.<\/p>\n\n\n\n<p>In the event policyholder\u2019s interests are affected adversely because of conduct of health care advisers, IRDAI said that it shall be immediately notified to the appropriate government or agency.<\/p>\n\n\n\n<p><a href=\"https:\/\/www.leadindia.law\/\">Lead India<\/a> lawyers will help you to understand the terms of the policies along with interpretation of hidden clauses of your policy.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>The Insurance Regulatory and Development Authority of India have observed that recently many hospitals are denying the cashless treatment facility to the policyholders. According to section 31 (d) of IRDAI, insurance companies shall have an agreement with private and public healthcare institutions. The list of network hospitals shall be published along with the policy document. &hellip;<\/p>\n<p class=\"read-more\"> <a class=\"\" href=\"https:\/\/www.leadindia.law\/blog\/en\/cashless-facility-cannot-be-denied-by-the-hospitals\/\"> <span class=\"screen-reader-text\">When Cashless claims can be denied by the Hospitals<\/span> Read More &raquo;<\/a><\/p>\n","protected":false},"author":4,"featured_media":1721,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[831,833,835,836,832,834],"class_list":["post-1720","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-general-legal-issues","tag-cashless-facility","tag-cashless-treatment","tag-file-complaint-against-hospital","tag-hospital-claims","tag-hospitals","tag-insurance-claim-complaint"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v26.0 - 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