Hospitals' Body Rejects Insurers' Advisory on Admissions for Fever
The Association of Healthcare Providers (India) (AHPI), which represents more than 21,000 hospitals, said the advisory should be seen only as a guideline and warned it would oppose any attempt by insurers to use it to deny cashless approvals or reject claims.
Hospital groups have rejected the General Insurance Council's (GIC) advisory on admissions for fever and infectious diseases, stating they will continue admitting patients based on doctors' clinical judgment, not insurer-backed guidance. The advisory is described as a non-binding note based on government treatment protocols and does not determine claim decisions.
The Association of Healthcare Providers (India) (AHPI), representing over 21,000 hospitals, warned that insurers should not use the advisory to deny cashless approvals or reject claims. The Association of Medical Consultants also rejected the advisory, expressing concern that GIC's stand could lead to the rejection of genuine claims, particularly reimbursement claims for individual policyholders treated at smaller hospitals.
Girdhar Gyani, director general of AHPI, emphasized that doctors should make clinical decisions, and GIC should stay out of it. Sudhir Naik, trustee of the Association of Medical Consultants, stated that the ICMR guidelines were already followed by doctors, and the concern was that the GIC advisory could become a tool for rejecting genuine claims, especially reimbursement claims from individual policyholders.
GIC clarified that the advisory reiterates treatment guidelines from government bodies and was issued in the public interest, not as a rule. The insurer also rejected concerns that the advisory would be used to deny claims, emphasizing that it does not determine claim decisions and that health insurers settled a significant amount of claims in 2024-25, with cashless claims accounting for a large portion of the total.
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