How to complain against hospitals if they refuse to give you cashless treatment


Many health insurance holders are facing difficulties in getting admissions to panel hospitals for cashless treatment amid a rising number of Covid-19 cases across the country. 

If you’re facing a similar issue, then you can file a complaint against hospitals if they refuse to give you cashless treatment. However, it’s advised that you should first consult with your Third-Party Administrator (TPA) to get cashless admission in the network hospital. 

However, if the hospital still denies admitting you or your patient on a cashless scheme, then you can file a formal complaint against the hospital. Here’s how you can either complain to your insurer or IRDAI. 

1. You can start filing your complaint with the help of the insurer’s Grievance Redressal Mechanism. The insurer needs to fully attend to the complaint within 15 days of registration. 

2. In case, you’re not satisfied with the response, you can go for the Integrated Grievance Management System (IGMS) option for escalating the complaint to IRDAI. IGMS facility allows policyholders to register their complaints and helps in its tracking as well. 

3. To file a complaint, you need to visit the official IGMS portal: https://igms.irda.gov.in

4.  You now need to register yourself by sharing information such as name, gender, date of birth, and your address, if you are a first time user. Otherwise, you can log in using your credentials.

5. After generating your credentials you need to log in to the portal and click on register complaint to file your complaint against the hospital/insurer. 

6. You can also register your complaint via email by sending a mail to [email protected] or calling on Toll-Free No. 155255 or 1800 4254 732.

Moreover, IRDAI has directed all insurers to remain in touch with hospitals so that its customers don’t face issues in claiming cashless treatment. “Insurers are advised to put in place an effective communication channel with all the network providers for prompt resolution of grievances of policyholders. Insurers are advised to report levying of excess charges or denial of the cashless facility to the respective State Governments for appropriate action,” it says.

Taking note of the situation, the Insurance Regulatory and Development Authority (IRDAI) has said, “There are reports of certain network providers (hospitals) charging high rates and insisting on cash payments from the policyholders for providing treatment to COVID-19 infected patients despite having a cashless arrangement with Insurers”.

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