Cashless health claim in just 15 mins at the time of discharge. Here's how

Sheeba’s father was all set to be discharged from the hospital at 10 am after the doctors gave the green light. She immediately set off to handle the discharge formalities. Her first stop was the Third Party Administrator (TPA) to settle the insurance claim and the final bill. The hospital quickly sent all the necessary documents to the insurer, but what should have been a straightforward process took a frustrating turn.

The insurer needed over two hours just to verify the documents. And if that wasn't enough, they demanded additional confirmations, leading to a back-and-forth exchange with the hospital. This endless communication chain meant that Sheeba’s father didn’t get the final clearance until 5 pm, a full seven hours after the initial discharge time. As he waited, his anxiety only grew, which wasn’t ideal for someone still recovering. Sheeba and her family, who were anxiously waiting to take him home, were equally distressed by the delays.

 

A common frustration

Sheeba's experience is not unique. Many families find themselves stuck in a similar situation, waiting hours after a doctor has confirmed a patient’s discharge before they can actually leave the hospital. The long wait times for processing cashless insurance claims have been a major pain point for many.

A new service to speed up discharge

Recognising this widespread issue, Policybazaar for Business, along with Paramount Health TPA and various insurance companies, has introduced the ‘15-Minute Express Discharge’ service. This new service aims to cut down the time patients spend waiting to be discharged after their doctor gives the go-ahead.

Typically, as in the case of Sheeba’s father, after a doctor confirms a patient’s discharge, the coordination between hospital departments and the TPA can drag on for hours. This new service is designed to ensure that once a discharge is confirmed, the entire process, including the insurance claim, is wrapped up in just 15 minutes, compared to the usual 5-6 hours.

Who can benefit from this service?

The ‘Express Discharge’ service is currently being piloted for employees of certain companies that have purchased Group Health Insurance from Policybazaar for Business and have agreed to participate in this new initiative.

Sajja Praveen Chowdary, Director & Head at Policybazaar for Business, explained, "The only point where the efficacy and relevance of Health Insurance is truly tested from the user’s perspective is when they need to raise a claim. Through our research, we’ve found that the wait time during discharge is one of the biggest sources of dissatisfaction for individuals during their hour of need.”

Atman Shah, Chief Operating Officer at Paramount Health TPA, added, "Express Discharge ensures that insured individuals and their families can be discharged within minutes, saving valuable time and energy that would otherwise be spent chasing documents. This initiative reduces emotional stress during critical stages and promises to enhance the overall customer experience, creating a win-win situation for everyone involved."

Push for quicker claims processing

In May 2024, the Insurance Regulatory and Development Authority of India (Irdai) took steps to address these issues by issuing a master circular on health insurance. The circular mandates that insurers must approve cashless claims within one hour and provide final authorization for hospital discharge within three hours. If the process takes longer than that, the insurer is required to cover any additional charges that may be incurred by the hospital.