The General Insurance Council in India is developing a new panel to ease hospital-insurer conflicts over cashless claims and treatment protocols, as industry disputes intensify with soaring premiums and claim rejections.
Health insurance disputes between hospitals and insurers are back under scrutiny in India, with the General Insurance Council saying it is working on a panel to reduce friction over cashless claims and treatment approvals.
The issue sharpened after the council issued guidance in July on outpatient care for uncomplicated fever and infectious diseases, saying hospital admission should be reserved for patients showing signs such as persistent high fever, dehydration or organ dysfunction. Hospitals worried the advisory could be used to refuse claims if discharge notes do not explicitly list those warning signs, but the council later said it was only reflecting existing Ministry of Health and Family Welfare and Indian Council of Medical Research guidance and did not override clinical judgement.
According to a report by ET Wealth, the council’s health insurance ecosystem chief executive, Dr S. Prakash, has been in talks with hospitals and insurers over recurring disputes, especially those linked to claim settlement and cashless tariffs. The council is also said to be framing a grievance redress mechanism and holding regular meetings between hospital and insurer representatives to build trust and reduce stand-offs.
Prakash’s broader remit comes at a time when policyholders are facing two of the industry’s most persistent complaints: claims being rejected or partly paid and renewal premiums rising sharply. Industry reports have said some customers have seen increases of 50% to 200% in recent years, fuelling frustration even as insurers and hospitals continue to argue over rates, treatment protocols and the role of third-party administrators. The council has argued that standardising costs and procedures could help ease tensions, while a separate health care regulator, if created, could give customers and providers a clearer route for dispute resolution.
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