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Despite policyholders being entitled for getting cashless treatment under their medical insurance policy, there are some reports that some hospitals are not granting cashless facilities for COVID-19 treatment.
The policyholders may send a complaint to the concerned insurance company in the event of denial of the cashless facility at any such enlisted network providers hospitals.
Insurance Ombudsman or the Grievance Redressal Officer can also be approached. Policyholders' complaints/grievances are looked into by the Grievance Redressal Cell in the Consumer Affairs Department of the Insurance Regulatory and Development Authority of India (Irdai). This Cell takes up the grievances with the respective insurers for redressal.
Here is how to file a complaint
First approach the Complaints/Grievance Redressal Cell of the insurer concerned if policyholders have complaints against insurers. Policyholders may approach the Grievance Redressal Cell in the Consumer Affairs Department of the Irdai if they do not receive a response from the insurer within a reasonable period which is usually 15 day of the complaint receipt or are dissatisfied with the response of the company.
Complaints from the insured or the claimants are entertained. Complaints written on behalf of policyholders by advocates or agents or by any third parties are not entertained by the Cell.
Complete details of the complaint as required in the complaint registration form, which can be downloaded from the IRDAI website – policyholder.gov.in (http://www.policyholder.gov.in/Report.aspx#) have to be submitted by the complainants.
Here's how to register complaints with the Irdai
-Policyholders can make use of the Integrated Grievance Management System(IGMS). It is an Irdai Portal at https://igms.irda.gov.in for registering the complaints and monitoring the status of the complaints.
-You can send the complaint through Email to complaints@irdai.gov.in.
-You can call Toll Free No. 155255 or 1800 4254 732
-If you want necessary to send the communication in physical form, the same can be sent to Irdai official addressed to: General Manager, Insurance Regulatory and Development Authority of India(IRDAI), Consumer Affairs Department – Grievance Redressal Cell, Sy.No.115/1, Financial District, Nanakramguda, Gachibowli, Hyderabad – 500 032.
