Exploring Changes to the 24-Hour Hospitalization Rule: Consumer Ministry Engages with Irdai and DFS
In a significant move prompted by advancements in medical sciences, the Consumer Ministry is set to discuss the minimum 24-hour hospitalization rule with the Insurance Regulatory and Development Authority of India (Irdai) and the Department of Financial Services (DFS), as reported by The Times of India (ToI).
The National Consumer Commission chief raised this issue on National Consumer Rights Day, with Justice Amreshwar Prasap Sahi expressing concerns about the existing condition that mandates a minimum 24-hour hospital stay for surgery-related claims to be accepted. Justice Sahi highlighted that some district forums have innovated by ordering claims to be paid even if the hospitalization is 23-and-a-half hours, arguing that advancements in medical treatments can now be completed within this timeframe.
Union Consumer Affairs Secretary Rohit Kumar Singh, in conversation with ToI, stated that discussions with Irdai and DFS will be initiated to find a resolution. Singh emphasized the need for consumer-friendly documentation processes, indicating previous discussions on introducing reforms in this regard.
Justice Sahi referred to “landmark decisions” by district consumer commissions in Punjab and Kerala regarding medical insurance claims. The ToI report highlighted a case in August 2023, where the Ferozpur District Consumer Commission held an insurance company accountable for wrongfully rejecting a medical claim based on hospitalization duration being less than 24 hours.
Consumer Affairs Secretary Singh commended the judgments of consumer commissions at district and state levels, leading to the disposal of 177,000 complaints this year against 161,000 fresh cases. The NCDRC boasted a case disposal rate of 200%, as per the ToI report.
As discussions unfold, these developments signal a potential shift in the healthcare insurance landscape, with a focus on adapting policies to align with modern medical practices and ensuring consumer-friendly procedures.
