Grievance redressal mechanism being framed to prevent hospital-health insurance stand-off

For the past four months, hospital representatives and insurers have convened monthly to resolve disagreements and establish trust‑building steps—such as digital‑system training and grievance‑handling procedures—according to Dr S Prakash, CEO of the General Insurance Council (Health Insurance Ecosystem and Strategic Partnerships).

These initiatives follow a series of tensions last year between hospitals and insurers that left many patients worried about whether their coverage would be accepted.

He said to businessline that this marks the first series of four round‑table discussions where payers and providers have reached alignment, involving groups such as the Association of Healthcare Providers of India (AHPI), physicians, and the General Insurance Council (which represents 32 firms). Dr Prakash assumed this position with the GI Council in January of this year.

Among the concrete proposals under discussion are standard treatment pathways for frequent illnesses, which would help set pricing, he noted. He added that a shared clinical pathway between payers and providers eliminates uncertainty, boosts trust in physicians and hospitals, and speeds up insurance settlements.

A core element of these monthly meetings is a grievance‑redressal platform linking hospitals and insurers. Described by Prakash as a “pre‑litigation conciliatory platform,” this formal forum aims to resolve disputes before they reach court. He stressed that resolving differences ensures the ecosystem works smoothly, protecting patients from inconvenience.

Capacity building

He also noted that training—or capacity building—in digital systems, particularly for smaller hospitals, is being planned to improve the use of cashless insurance and reimbursement processes. Talks are progressing with the Quality Council of India (QCI, an autonomous government body) and the National Accreditation Board for Hospitals and Healthcare Providers (NABH) to streamline the fragmented elements of the system, Prakash said. Emphasizing the vital role of primary care facilities close to communities, he argued they must be strengthened to offer insurance coverage.

Published on June 3, 2026