Discharge delayed while waiting for the insurer's final approval — what are the rules?

IRDAI's health master circular requires the insurer to grant final authorisation within three hours of receiving the hospital's discharge request, and says the patient must not be made to wait in hospital for it. If the delay goes beyond three hours, any extra amount the hospital charges because of it is to be borne by the insurer from its shareholders' funds. Note the times, ask the desk when the request was sent, and keep the bill showing any extra charge.

The doctor has said you can go home, the bags are packed, and the hospital desk says it is 'waiting for the insurance'. IRDAI has set rules for exactly this moment, and knowing them helps you ask the right questions at the desk and afterwards.^[1]

The rules that apply at discharge

• Three hours for final authorisation: The insurer must grant final authorisation within three hours of receiving the hospital's discharge authorisation request, and the policyholder must not be made to wait to be discharged.^[1]
• Extra charges after three hours: If the delay goes beyond three hours, any additional amount the hospital charges is to be borne by the insurer from its shareholders' funds.^[1]
• If the patient dies during treatment: The insurer must process the claim immediately and get the body released from the hospital immediately.^[1]

When does the clock start?

The clock runs from when the insurer receives the hospital's discharge authorisation request, not from when the doctor clears you to leave. The hospital may first need to prepare the final bill and discharge papers before it sends the request, so ask the insurance desk what time the request went to the insurer or TPA. Insurers may also run help desks at hospitals for cashless requests; if there is one, ask there too.^[1]

What to record while you wait

1. 1

   The time the doctor cleared discharge

   Note it, and ask for it to be written on the discharge summary if possible.

2. 2

   The time the request was sent

   Ask the desk for the time the final request went to the insurer or TPA, and for a screenshot or email if they will give one.

3. 3

   The time approval came

   Note the time on the final authorisation letter.

4. 4

   Any extra charge

   Check the final bill for room, nursing or other charges that relate to the waiting period, and keep the itemised bill.

5. 5

   Who you spoke to

   Names of desks, and any reference numbers given to you.

If you were charged because of the delay

Write to the insurer with your times and the itemised bill, quote the rule that extra charges caused by a delay beyond three hours are borne by the insurer, and ask it to bear or repay that amount. The insurer should resolve the complaint within 14 days.^{[1, 2]}

ClaimAssure is an independent private platform. It is not an insurer, IRDAI, Bima Bharosa or the Insurance Ombudsman, it never files anything on your behalf, and it cannot promise any outcome. What it does is read your documents and show you what they say.

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