The Insurance Regulatory and Development Authority of India has mandated faster timelines for health claims. One hour for cashless pre-authorisation during treatment. Three hours for discharge authorisation.

If you have stood at a hospital counter while the billing desk said abhi approval aayega, you know how heavy one hour can feel. The good news is simple. Insurers now have to decide cashless authorisation within one hour and clear discharge authorisation within three hours. That means less limbo for you, faster clarity for doctors, and a calmer ride home.

Key Points covered in this blog:

• What actually changes for you: Cashless decisions must come within one hour during treatment. Final discharge authorisation must come within three hours. If discharge gets delayed beyond that because of the insurer, extra charges can fall on the insurer, not on you.
• Why the counter will move faster now: Hospitals, TPAs, and insurers are aligning documents and data. The timelines create pressure to respond quickly instead of pushing you to swipe a card and “settle later.”
• How to prepare before admission: Keep your e-card, Aadhaar, PAN, policy number, and TPA contact saved on your phone and printed in a small folder. Share a quick summary of current diagnosis, past history, and regular medicines with the treating doctor so the pre-auth note is crisp. One clear note saves hours.
• Smart habit for families in Ahmedabad and across Gujarat: Shortlist two or three reliable network hospitals near home and work. Call their cashless desks once, note timings and documents they prefer, and store the numbers. A five minute call today prevents a one hour wait on the hardest day.

Want a quick check on your policy’s cashless readiness. Talk to Sharmaji.

The new timelines, in plain language

Insurers must decide cashless authorisation within one hour of the hospital’s request. Final discharge authorisation must land within three hours. If delay crosses three hours, any extra amount charged by the hospital is on the insurer. The regulator also wants insurers to push toward near total cashless, not reimbursement.

• One hour for pre-auth: Your insurer has up to one hour to approve or reject the cashless request once the hospital sends it. Insurers were told to put systems in place by July 31, 2024.
• Three hours at discharge: When the hospital sends the discharge request, the insurer must issue final authorisation within three hours. If the hospital bills extra because the approval came late, that extra is payable by the insurer from shareholder funds.
• Toward 100 percent cashless: The circular directs insurers to strive for full cashless settlement and keep reimbursements as rare exceptions. This shifts effort to standardised, faster, paper-light flows.
• Your experience improves where docs are tight: The same circular tells insurers and TPAs to collect documents directly from hospitals, not from you. Cleaner paperwork, fewer back-and-forth calls.

Save this line in your phone notes: e-card, policy number, TPA contact, Aadhaar, PAN, treating doctor’s one-line summary. That combo unlocks the one hour and the three hours.

NHCX is the new highway for claims

NHCX is a government-backed rails system for health claims. One format. One secure pipe. Less back and forth. As of July 2024, 34 insurers and TPAs were live on NHCX and about 300 hospitals were ramping up to send claims. Media reports also counted 33 major health insurers on the platform. The goal is simple. Cleaner data in. Faster decisions out.

• What is NHCX: A common exchange built by the National Health Authority with support from IRDAI. It standardises the way hospitals, TPAs, and insurers share claim data.
• Why you should care: Standard forms mean fewer missing fields and fewer repeat emails. That directly supports the one hour pre-auth and three hour discharge targets.
• What you will notice at the counter: The cashless desk uploads a uniform pre-auth package. The TPA sees exactly what the doctor wrote, with clear codes and itemisation. Less interpretation. Quicker yes or no.
• Adoption status: 34 insurers and TPAs live on NHCX with roughly 300 hospitals onboarding, and widespread industry participation reported through July 2024. Expect steady expansion across large private hospitals first, then mid-tier networks.
• Privacy and safety: The exchange is being rolled out with a focus on secure data handling and standard protocols. Your documents move through a controlled lane, not scattered emails.

When in need, call your preferred hospitals and ask a simple line: ‘Are you NHCX ready?’ If not, carry our one page checklist so your file is complete on day one.

Costs are up. Preparation beats panic.

Healthcare got pricier. The Acko Health Insurance Index reports medical inflation around 14 percent, and average claim size up by 11.35 percent year on year. That is the backdrop for the one hour and three hour promises. Faster cashless helps your nerves. The right cover helps your wallet.

What this means for your cover:

• Recalculate sum insured using today’s procedure prices. Angioplasty now often bills in the range of two to three lakh. Kidney transplants are commonly ten to fifteen lakh. A five lakh cover can crack under one big event.
• Add a super top up. Keep your base at a comfortable premium. Layer a super top up to jump your total cover to twenty or thirty lakh without burning cash. It is the most cost effective upgrade for families that already have basic cover.
• Watch the room rent cap. A cap can trigger proportionate deduction on many line items if you pick a higher room. Ask for plans with no room rent limit or at least a realistic cap for your city.
• Check sub limits and co pays. Maternity, cataract, robotic surgery, implants. If a sub limit exists, get clarity in writing. Co pay may look harmless at 10 percent, but on a five lakh bill it is fifty thousand out of pocket.
• Plan an annual step up. If inflation sits near low double digits, stepping up your sum insured each renewal is a sane habit. It keeps today’s five lakh from becoming tomorrow’s shortfall.
• Keep a network short list. Two or three solid cashless hospitals near home and work. Save the cashless desk numbers and desk hours. Faster documents in means faster approvals out.

Sharmaji’s quick rule:
Cover for big risks first. Protect the heart, kidneys, ICU days, and expensive implants. Frills can wait. Peace comes from knowing one serious admission will not break your savings.

Not sure if your cover can handle a real bill in Ahmedabad. Share your sum insured and family size. Sharmaji will run a quick adequacy check.

Step one, breathe. Step two, show your e-card.

Stress drops when the file is tidy. This is the exact flow I teach every family. Save it. Share it. Practice it once when no one is ill. On the hard day, you will glide.

Admission checklist

• Photo ID, Aadhaar, PAN
• Insurer e card and policy number
• TPA name and helpline
• Treating doctor name and department
• Past history, current medicines, allergies
• Corporate cover details if you have two policies

Pre authorisation prep

• Ask the doctor for a crisp clinical note. Chief complaint, provisional diagnosis, planned line of treatment, estimated stay. One clean note avoids back and forth.
• Confirm your room category before admission. If your plan has a room rent cap, pick a room inside that limit. This protects you from proportionate deductions later.
• At the cashless desk, share your folder and phone number. Request the reference number for the pre auth request. Save it in your messages.

During hospital stay

• Request a daily estimate. Keep a photo of each interim bill. Spot items that your plan excludes, like personal comfort items.
• If a new procedure is added, ask the doctor to update the note and ask the desk to send a revised pre auth. Mid course clarity prevents last day surprises.
• If the TPA asks for clarifications, help the nurse and doctor respond same day. Speed comes from complete notes, not louder calls.
• On day two of a long stay, ask the desk to confirm that all mandatory documents are already in the file. Discharge moves fast when files are complete.

Discharge day flow

• Tell the nurse early that you plan to leave today. This triggers the discharge file.
• Hospital sends the final bill and summary to the TPA. Start a three hour timer once they confirm the request is sent.
• While the timer runs, review line items. Pharmacy, implants, devices, consumables, procedure codes. Ask for corrections immediately so the final authorisation matches the corrected bill.
• Keep the treating doctor reachable for any last clarifications. A quick line from the doctor can shave minutes.
• If three hours pass after the request was sent and the approval is still pending, ask the desk to note the time in writing. Stay calm. Late approval charges should not fall on you when delay is on the insurer side.
• Before you leave, collect the discharge summary, all reports, a stamped final bill, and a receipt that clearly says settled through cashless.

If you are admitted in a non network hospital

• Ask if a network branch or partner facility is available and safe to shift to.
• If not, keep all originals. You can still file a reimbursement claim. Ask the hospital to write a clear reason why cashless was not possible. This note helps at settlement.

Sharmaji’s pocket folder
Front pocket

• e card printout
• Photo ID, Aadhaar, PAN
• Policy schedule first page
  Back pocket
• Past history sheet with medicine list
• Emergency contacts
• A simple note that says blood group, allergies, and treating doctor number

Want this as a one page printable? Just text us on What’sapp.

Small misses cause big holdups

Most cashless delays are not bad luck. They are tiny gaps in forms, room choices, or policy rules. Close these gaps and the one hour and three hour targets start working for you.

The usual traps and Sharmaji’s fixes

• Non disclosure or half disclosure of past illness
  If a doctor note or old report reveals something you did not declare, expect questions. Waiting periods also apply to many pre existing conditions. The regulator has tightened timelines in your favour, but honesty at proposal time is still the best shield. Recent updates cut the maximum waiting period for pre existing diseases to three years. The moratorium has moved to five years of continuous cover, after which non fraud claims should not be rejected for non disclosure. Keep renewals on time. Keep declarations clean.
• Room rent cap triggers proportionate deduction
  Pick a room above your eligibility and many associated charges can get scaled down. That is the classic proportionate deduction trap. Choose a plan without room rent limits or stay within the limit. If your hospital does not do differential billing, proportionate deduction should not apply. Many policies also keep pharmacy, diagnostics, and implant costs outside the proportionate cut. Read your wording or ask us to check.
• Missing KYC or bank details
  KYC gaps and wrong account numbers slow reimbursements and can hold up final authorisations. Carry Aadhaar, PAN, a cancelled cheque or passbook copy, and your insurer e card. Share the same with the cashless desk on day one.
• Sub limits and co pays hidden in fine print
  Cataract, robotic surgery, maternity, mental health sessions, implants. If there is a sub limit or co pay, it will be applied. Ask for a written estimate against your plan rules before admission. If costs will cross a limit, request an add on approval or consider a network facility with better bundled rates.
• Non network admission
  Cashless usually fails outside the network. If safe, shift to a network hospital early. If not, keep every original bill and report for reimbursement. Ask the hospital to write a short note on why cashless was not possible. That note helps at settlement.
• Vague doctor notes
  TPAs respond faster to clear clinical notes. Request a crisp line from the treating doctor on diagnosis and plan. If the plan changes, ask the desk to send a revised pre auth the same day.
• Implants and high value items without proof
  Stents, valves, implants, special devices. Keep invoices, stickers, and batch numbers in the file. It avoids last minute queries at discharge.
• Two policies, no coordination
  Tell the desk if you have corporate plus retail, or two retail covers. Decide the lead policy and share both e cards. Ask the TPA to set up coordination so you do not overpay and chase refunds later.
• How to escalate when the clock slips
  Record time stamps when the hospital sends discharge documents. If the three hour window passes, request a written note from the desk. Escalate through your insurer’s grievance channel and then through the Bima Bharosa IGMS portal if needed. If there is no resolution within 30 days, approach the Insurance Ombudsman. Keep emails, WhatsApp screenshots, and bills handy.

Sharmaji’s short rule:
Tidy file. Clear notes. Right room. Honest forms. That mix beats delays every time.

Want a pre treatment policy review for your family. Call Sharmaji.

What hospitals and TPAs must do faster now

Timelines are tight. That means hospitals and TPAs have to tighten their files, code correctly, and send complete notes the first time. When they do their part, your part gets easier.

What the hospital cashless desk should do

• Send a clean pre auth pack. Photo IDs, e card, policy number, treating doctor note, provisional diagnosis, planned procedure, estimated stay, itemised cost. One complete packet beats three incomplete ones.
• Code it right. Use correct diagnosis and procedure codes. Clear codes stop back and forth.
• Share a daily estimate. Short stays change fast. A running estimate prevents last day shocks.
• Start discharge early. Begin compiling discharge summary, pharmacy breakup, device invoices, and stickers by noon on the final day.
• Time stamp the send. When the discharge file goes out, record the time and share the reference number with you. It sets the three hour clock cleanly.
• Keep the doctor reachable. Many queries clear with a one line doctor confirmation.

What the TPA should do

• Acknowledge with a reference number. You deserve a clear URN or case ID for every pre auth or discharge request.
• Ask all queries together. Consolidated questions save hours. Piecemeal queries waste everyone’s time.
• Escalate fast for high risk cases. ICU, implants, multi specialty involvement. A senior reviewer should be on it quickly.
• Coordinate multiple policies. If you have corporate plus retail, set lead policy and contribution up front so bills do not bounce on discharge day.
• Work the clock. When three hours are close, the TPA should push the insurer reviewer and keep the hospital desk updated.

Your polite asks at the counter

• Please share the pre auth reference number on SMS or WhatsApp.
• Please note the exact time when the discharge file was sent.
• If you have queries, can you send them together in one message.
• Can the treating doctor add one clear line on diagnosis and plan if needed.

Tell the billing desk in the morning that you plan to go home today. That one line triggers a smoother discharge file.

The three hour rule, and your rights

Timelines protect you only when the clock is visible. Make time your ally.

Do this the moment discharge papers go out

• Ask the cashless desk to confirm, in writing or WhatsApp, that the discharge file has been sent.
• Note the exact time. Start your own three hour timer on the phone.
• Keep the treating doctor reachable for any medical clarifications.

If three hours pass

• Request the desk to log a simple note: discharge authorisation pending beyond three hours.
• Ask the TPA for a single consolidated query list, not piecemeal asks.
• Stay calm at the counter. Do not swipe your card unless the hospital writes that delay is due to insurer side and you will be refunded once authorisation lands.

Escalation ladder that works

1. Insurer helpdesk and grievance email with your case ID, hospital name, time stamps, and a photo of the final bill.
2. Bima Bharosa IGMS portal if you do not get a proper response. Upload the same documents, plus the hospital note.
3. Insurance Ombudsman if it still drags. Keep every WhatsApp, email, and bill copy handy.

What not to sign

• Any blank form.
• Any note that says you will bear extra room charges due to insurer delay. Push for a neutral note that simply records the time line.

Two one page helpers from Sharmaji

Hospital desk checklist

• Photo ID, Aadhaar, PAN
• Insurer e card, policy number, TPA name and helpline
• Treating doctor name, department, mobile
• Past history, current medicines, allergies
• Corporate cover details, if any
• Room category chosen, checked against plan eligibility
• Pre authorisation reference number saved
• Daily estimate photographed
• Revised pre authorisation sent if plan changes

Discharge day cross check

• Discharge summary ready and accurate
• Pharmacy breakup itemised, quantities correct
• Implants and devices with invoice, sticker, and batch numbers
• Diagnostics and procedures coded correctly
• Final bill corrected before authorisation
• Discharge file sent time noted, three hour timer started
• Final authorisation received, amount matches corrected bill
• Receipt clearly states cashless settlement
• Copies of all documents filed at home

Don’t let a medical emergency turn into a financial one. Talk to Sharmaji today for a pre-treatment policy review, so you can be fully prepared.