Stuck at discharge, waiting for the insurer?
Waiting for hours at the hospital after the doctor has said you can go home is exhausting. IRDAI has set clear time limits for cashless approvals, and the cost of a late approval is meant to fall on the insurer, not on you.
The time limits
- A cashless pre-authorisation request must be decided immediately, and within 1 hour of the insurer receiving it.
- The final discharge authorisation must be given within 3 hours of the insurer receiving the hospital’s request. IRDAI says the patient should not be made to wait for discharge.
- If the approval takes longer than 3 hours, any extra amount the hospital charges for the delay is borne by the insurer from its shareholders’ funds.
- If a patient dies during treatment, the insurer must process the claim immediately and have the body released from the hospital straight away.
When the 3 hours start
The clock runs from when the insurer receives the hospital’s final discharge request, not from when the doctor clears you to leave. Hospitals often take time to prepare the final bill and send it. Ask the insurance desk when the request went out, and note the time yourself.
What to do while you wait
- Ask the hospital’s insurance desk when it sent the final bill to the insurer or TPA, and whether the insurer has raised a query.
- Write down the times: discharge advised, request sent, approval received.
- If it is past 3 hours, call the insurer’s helpline, register a complaint and note the complaint number. You can also call Bima Bharosa on 155255.
- If the hospital adds a charge for the extra hours, keep the bill that shows it.
If you paid extra because of the delay
Write to the insurer’s Grievance Redressal Officer with the times you noted and the bill, and ask for the extra amount back under the 3-hour rule. If the reply doesn’t settle it, not following IRDAI’s rules is a ground for an Insurance Ombudsman complaint.
If cashless was cut or refused
A cut in the final cashless approval is a partial settlement. You can pay the difference, then challenge it in writing like any other deduction. See our guides on cashless denials and partly paid claims.
Questions people ask
Is the 3-hour discharge rule an IRDAI rule?
Yes. IRDAI’s Master Circular on Health Insurance Business (29 May 2024) says the insurer must decide on the final discharge authorisation within three hours of receiving the hospital’s request.
Who pays if the hospital charges for the extra time?
Under the same circular, any additional amount the hospital charges because the approval took longer than three hours is borne by the insurer from its shareholders’ funds.
How fast must a cashless request be decided at admission?
Immediately, and within one hour of the insurer receiving the pre-authorisation request.