Navigating Changes to 24-Hour Hospitalization Rule: Consumer Ministry Collaborates with Irdai and DFS
In response to advancements in medical sciences, the Consumer Ministry is poised to deliberate the minimum 24-hour hospitalization rule with the Insurance Regulatory and Development Authority of India (Irdai) and the Department of Financial Services (DFS), as per a report by The Times of India (ToI).
The National Consumer Commission chief’s concern, voiced on National Consumer Rights Day, centres on the stipulation requiring a 24-hour hospital stay for surgery-related claims to be approved. Justice Amreshwar Prasap Sahi highlighted innovative approaches by some district forums, advocating for claim approval even with a 23-and-a-half-hour hospitalization, citing accelerated medical treatments.
Union Consumer Affairs Secretary Rohit Kumar Singh, in a conversation with ToI, revealed plans to engage in discussions with Irdai and DFS for a viable solution. Singh underscored the importance of consumer-friendly documentation processes, echoing previous talks about introducing reforms.
Justice Sahi referenced “landmark decisions” by district consumer commissions in Punjab and Kerala regarding medical insurance claims. The ToI report spotlighted a case in August 2023 where the Ferozpur District Consumer Commission held an insurance company accountable for wrongfully rejecting a medical claim based on hospitalization duration of less than 24 hours.
Consumer Affairs Secretary Singh lauded the judgements of consumer commissions at district and state levels, resulting in the disposal of 177,000 complaints this year against 161,000 fresh cases. The NCDRC boasted a case disposal rate of 200%, as per the ToI report.
These unfolding discussions signal a potential paradigm shift in healthcare insurance, with a focus on aligning policies with modern medical practices and streamlining procedures for enhanced consumer friendliness.