Disputes Resolution Portal

GI-COUNCIL with the support of Insurance Companies, launches this Disputes Resolution portal

General Insurance Council, with the support of Insurance Companies, launches this Disputes Resolution Portal to resolve Grievances of the Hospitals.

To begin with, only limited complaints relating to nonpayment of authorised Cashless Claims will be taken up by the Council for resolution.  Details of complaints to be taken up are available in the link shared below.

This exercise will be taken up on a Pilot basis for the States of Maharashtra, Tamil Nadu and Karnataka.  Soon it will be expanded to other States.

A Committee constituted by General Insurance Council,  comprising  of representatives from hospitals, insurance companies and TPA’s, will examine the eligible Complaints and endeavour to get them resolved.        

All Disputes along with supporting documents should be submitted by the concerned Hospital in soft copy format at the portal, at the link below:

https://hospitaldisputeresolution.gicouncil.in/

About HDPR – Hospitals Dispute Resolution Portal

DISPUTE REDRESSAL PORTAL

This Dispute Redressal Portal will facilitate the quicker resolution of issues faced by hospitals. The portal provides a platform for hospitals to submit their Disputes. This Portal is meant only for Hospitals who wish to submit a Dispute relating to an Insurance Company or a Third-Party Administrator.

This Portal classifies Provider Disputes into two Types: Type A and Type B.

TYPE A DISPUTE:

Type A Disputes would be taken up by the General Insurance Council for Resolution. A dispute will come under Type A if it meets the following criteria:

1. The Dispute should relate to non- payment for a Cashless Treatment for which the Final Authorisation has been issued by the Insurance Company.

2. The Dispute was already referred to the usual resolution channel at the Insurance Company.

3. The Dispute should be raised by the Hospital within a period of 120 days from the date of Cashless Preauthorisation.

4. The amount in dispute should be more than ₹20,000.

Type A Disputes will be taken up by the Council for resolution, and a decision on the same will be communicated to the Parties.

TYPE B DISPUTE:

Any other complaints about the Insurance Company or the Third Party Administrator will fall under Type B Disputes. Type B Disputes submitted in this Portal will be forwarded by the Council to the Insurer for resolution. Further action on Type B Disputes will be taken up by the concerned Insurance Company. Council will not be able to provide further information on action taken by the Insurance Company for Type B Disputes.

Sources:

GI-COUNCIL with the support of Insurance Companies, launches this Disputes Resolution portal

GIC Initiatives – Hospitals Disputes Resolution portal