Mumbai, March 10: Insurance companies have been advised to reduce claim rejection rates, while hospitals have been asked to keep treatment charges reasonable, during a key meeting convened by Maharashtra Health Minister Prakash Abitkar with representatives of private hospitals, insurance firms and the Insurance Regulatory and Development Authority of India (IRDAI) at Mantralaya on Tuesday.
Meeting focuses on claim approvals and billing concerns
The meeting focused on addressing difficulties faced by patients in getting insurance claim approvals during treatment and concerns over excessive medical billing.
Representatives of private insurance companies, hospitals, IRDAI and the state health department came together on a single platform to discuss and frame a clear framework aimed at improving coordination and ensuring patient welfare.
Speaking at the meeting, Abitkar said that although hospitals and insurance companies operate on a commercial basis, it is essential to ensure that common citizens do not face injustice.
He noted that the number of hospitals offering advanced healthcare services as well as private health insurance holders is steadily increasing in major cities like Mumbai and Pune.
Directions to hospitals and insurers
He directed that all hospitals in the state should register on the IRDAI portal and keep the required information updated. He also emphasised the need to set a fixed time limit for claim approvals.
Lack of coordination between hospitals and insurance companies often leads to mental and financial stress for patients, he said, adding that the government would take necessary steps to make the claim process more transparent and easier while ensuring patients receive timely treatment.
Action against irregularities and push for transparency
According to the Health Department, around 7,000 to 8,000 hospitals in Maharashtra currently provide services linked to insurance schemes. However, the government has received complaints about certain irregularities in some cases.
The minister directed officials to take action under the Bombay Nursing Act wherever malpractice is found. He also suggested making it mandatory for major hospitals to prominently display treatment rate charts for transparency.
Plan for standard protocols and data monitoring
The meeting also highlighted the need to develop standard treatment protocols as charges for the same medical condition often vary across hospitals. The government is also considering establishing a common empanelment mechanism for hospitals and insurance companies.
Hospitals and insurers were further directed to regularly submit data to the health department regarding the number of admitted patients, approved and rejected claims, and complaints received.
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IRDAI officials said complaints from Maharashtra will be collected and studied to formulate corrective measures, with the state set to become the first in the country to initiate such a coordinated mechanism.
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