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State meets stakeholders to streamline medical claim process
The meeting was held to discuss the need for a clear mechanism to ensure transparency in medical billing and timely approval of insurance claims.
Pune: While insurance companies and hospitals function on commercial lines, it is essential to ensure that patients are not subjected to unfair practices, said Prakash Abitkar, Maharashtra health minister, during a meeting held on Tuesday with representatives of the Insurance Regulatory and Development Authority of India (IRDAI), private insurance companies, private hospitals and officials of the state health department.
The meeting was held to discuss the need for a clear mechanism to ensure transparency in medical billing and timely approval of insurance claims.
Abitkar noted that with the increasing number of private hospitals providing advanced healthcare services in cities such as Pune and Mumbai, the number of people purchasing medical insurance has also grown.
“Medical insurance is becoming increasingly important, and hospitals and insurers must work to strengthen trust in the system. The patient must remain at the centre of all decisions,” the minister said.
The minister directed hospitals across the state to register on the IRDAI portal and keep the information up to date. He also emphasised the importance of establishing a fixed timeline for approving insurance claims to prevent delays that often cause financial and emotional stress for patients.
According to officials, currently around 7,000 to 8,000 hospitals in Maharashtra provide insurance-linked healthcare services, and the government has received complaints regarding irregularities in some cases. Abitkar warned that strict action would be taken under the Bombay Nursing Act against hospitals found violating rules. He also suggested that large hospitals should display treatment tariffs to ensure transparency for patients.
During the meeting, members also discussed the need to develop standard treatment protocols, as treatment costs for the same disease often vary significantly across hospitals. “The government is also considering setting up a common empanelment system for hospitals and insurance companies to streamline the process,” Abitkar said.
Insurance companies were asked to reduce claim rejection rates, while hospitals were instructed to keep treatment costs reasonable. Hospitals will also be required to regularly submit data to the health department regarding the number of patients admitted, claims approved or rejected, and complaints received.
As per officials, the IRDAI will also analyse insurance-related complaints from Maharashtra and suggest measures to address them.
