health insurance claims

Necessary To Determine Claims Ratio, Underwriting Profits

Lawyers and consumer rights experts argue that procedural delays should not automatically extinguish a genuine claim, especially when the insurer does not otherwise dispute its validity or admissibility.

In a bid to enhance policyholder rights, insurance companies are required to resolve claims within 30 days, while investigations for health claims should conclude in 30-45 days, and for life policies, within 90 days. Failure to meet these deadlines results in interest penalties.

“The idea behind two-hour hospitalisation coverage is that all medically necessary procedures admissible under the policy will be covered, irrespective of the duration of the hospital stay,” says Mayank Bathwal, CEO, Aditya Birla Health Insurance

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New AI systems are now available to combat fraud in the Ayushman Bharat health insurance scheme. These advanced tools can identify fake hospital bills and forged medical documents. The technology aims to speed up insurance claim settlements and enhance transparency. India is leading the Global South with its health AI benchmarking platform.

At a practical level, what employees experience will depend on where they work and how the rules are implemented. For example, an employee in a bank or insurance company, where the central government is the appropriate authority, may begin experiencing more standardised compliance with working hours.

Company said claim was rejected and failed to reimburse the hospital bill

In a worrisome development, hospitals in Bihar enrolled in the Ayushman Bharat scheme are grappling with significant financial challenges. Payments for cashless treatments provided to low-income patients have been delayed for more than four months, leading to unpaid dues that run into crores. This financial crisis is threatening the livelihoods of staff, the availability of essential medicines, and daily operations.

West Bengal's new BJP government is enacting swift policy changes, replacing TMC schemes with central programs like Ayushman Bharat and Annapurna Yojna. Mandatory 'Vande Mataram' in schools, revised OBC reservations, and increased age limits for government jobs are among the key decisions. The administration is also scrutinizing caste certificates and initiating corruption probes.

Your pension has always been meant for retirement. Now, PFRDA wants to allow you to double it up as a healthcare cushion too.

Private hospitals in Kolkata are refusing or restricting admissions for Swasthya Sathi beneficiaries as they await clarity on the scheme's future under the new government. Hospitals cite concerns over the scheme's profitability and are unofficially suspending admissions, impacting patients seeking treatment.

A pregnant 15-yr-old’s ordeal again underscored the conceptual flaw in our abortion law. MTP law, despite amendments, makes terminating pregnancy an arbitrary process. Everyone has a say, except the woman

Tamilaga Vetri Kazhagam's manifesto, spanning 94 pages, outlines comprehensive promises for Tamil Nadu voters. Key pledges include monthly financial aid for women, free bus rides, and healthcare initiatives. The party also committed to youth development, farmer support, police reforms, and economic revival for MSMEs and weavers.