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Government Initiates Dialogue with IRDA for Review of 24-Hour Hospitalization Rule in Health Insurance Policies




The Consumer Affairs Ministry has announced that it will bring up the urgent issue by the head of the National Consumer Commission with the Department of Financial Services (DFS) and the Insurance Regulatory and Development Authority of India (IRDAI). The issue is that insurance companies will not pay medical claims if a policyholder is not hospitalized for at least 24 hours to receive surgery or other treatment.


"The President of the National Consumer Disputes Redressal Commission (NCDRC)."" is the revised and corrected version of the text., Justice Amreshwar Prasap Sahi stressed the necessity of reevaluating this section during a speech at an event honoring National Consumer Rights Day. Justice Sahi emphasized how medical procedures are changing and that advances in the field have made it possible to complete operations and treatments in hours.



"The claims will only be recognized if the patient is admitted for surgery in the concerned hospital for at least twenty-four hours. This frequently comes up in medical malpractice and claim lawsuits. Some district forums took a creative approach and mandated that the claims be paid, regardless of the 23-and-a-half hours. 

They have supported this by arguing that multiple "Medical treatments can now be completed within less than a day." Thus, according to Justice Sahi, it is necessary to inform the insurance providers of this.


Union Consumer Affairs Secretary Rohit Kumar Singh stated that the ministry will work with IRDAI and DFS to find a workable solution, reaffirming the ministry's commitment to consumer interests. Singh declared, "We will bring this up with IRDA and DFS to find a solution in customers' best interests. We had previously conducted discussions on matters about the insurance industry and how to implement changes to make the paperwork and procedures more user-friendly. Our goal is to resolve conflicts and develop solutions."


Judge Sahi applauded the district consumer commissions in Punjab and Kerala for their efforts in establishing "landmark orders" about laws concerning medical insurance claims. He gave an example of how the Ferozpur District Consumer Commission had penalized an insurance provider for erroneously denying a claim for medical care because the patient had been hospitalized for less than twenty-four hours.


Justice Sahi expressed worries about the difficulties in carrying out these instructions even as he acknowledged the improved efficiency in handling complaints. He underlined that to improve the efficacy of consumer justice, a uniform execution plan is essential.


Next Steps

The government's initiative to engage IRDAI to review the 24-hour hospitalization rule marks a positive step towards aligning health insurance policies with the evolving healthcare landscape. The dialogue between the government and the regulatory authority is expected to involve stakeholders from the healthcare and insurance sectors to ensure a holistic and well-informed decision-making process.


Conclusion

As the government takes a proactive stance in addressing the changing dynamics of healthcare, the potential revision of the 24-hour hospitalization rule holds promise for a more responsive and inclusive health insurance framework. The outcomes of this review are eagerly anticipated by the insurance industry and the general public, as they can potentially shape the future of health insurance policies in India.


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