Quick answer: Under the IRDAI Master Circular on Health Insurance dated 29 May 2024, insurers must decide on a cashless authorisation request within one hour of receiving it from the hospital, and grant final authorisation at discharge within three hours of the hospital’s request. In practice, delays usually come from incomplete paperwork, so preparing documents early makes a real difference.
The two approvals in a cashless claim
| Stage | What happens | IRDAI timeline |
|---|---|---|
| Pre-authorisation | The hospital sends your details, diagnosis and estimated cost to the insurer or TPA | Decision within 1 hour of receiving the request |
| Final authorisation at discharge | The hospital sends the final bill and discharge summary | Within 3 hours of the hospital’s request |
The circular also says that if discharge approval is delayed beyond three hours, any extra charges the hospital levies because of the delay are to be borne by the insurer, not the patient.
What slows approval down
- Missing or unclear documents from the hospital
- Incomplete medical details, such as diagnosis or treatment plan
- Questions about pre-existing conditions, waiting periods or exclusions
- Name or policy details that do not match ID documents
- Requests sent late in the day or on weekends, when hospital desks are busy
How to speed things up
- For planned treatment, send the pre-authorisation request a few days before admission, not on the day.
- Carry your insurance card or policy number, photo ID and previous medical records.
- Check details such as name spellings and policy numbers match your ID.
- Ask the insurance desk for the request reference and time it was sent.
- Follow up with your insurer or TPA, quoting that reference, if there is no decision.
Read our full guide to how cashless and direct-billing treatment works, and what to do if a cashless claim is only partly approved.
Pre-authorisation for planned vs emergency admissions
For planned treatment, the hospital can send the request before admission, often a few days ahead, so approval is ready on arrival. For an emergency, treatment starts first and the hospital sends the request as soon as possible after admission. In both cases, the insurer may ask follow-up questions, and the clock effectively restarts when a complete request with all details is received.
What the hospital usually sends
- Pre-authorisation form with diagnosis and planned treatment
- Doctor’s notes and relevant reports
- Estimated cost and expected length of stay
- Your policy and ID details
If you know your policy details and have your reports organised before admission, the insurance desk can send a complete request the first time, which is the single biggest help in avoiding delays.
If approval is refused
If the insurer declines cashless approval, ask for the reason in writing. Sometimes more documents will change the decision; sometimes the treatment is not covered. You can still proceed by paying and claiming reimbursement if you believe the claim is valid, and you can raise a grievance with the insurer and then through IRDAI’s Bima Bharosa system. See why a cashless claim may be only partly approved.
Keeping a note of every reference number, time and name you speak to makes any follow-up with the insurer much faster.
How NEIMHAANS helps
NEIMHAANS is a non-clinical healthcare concierge that has helped families travelling for treatment since 2007. For planned treatment, we help families prepare the documents hospitals need for pre-authorisation, start the request early, and follow up so discharge day is not spent waiting. We do not sell insurance or give insurance or legal advice; your insurer, TPA or the scheme has the final word on coverage. See our services.
Frequently asked questions
How long does an insurer have to approve a cashless request?
Under the IRDAI Master Circular on Health Insurance dated 29 May 2024, insurers must decide on a cashless authorisation request immediately and within one hour of receiving it from the hospital.
How long can discharge approval take?
The same circular requires final authorisation on discharge within three hours of the hospital’s request. If there is a delay beyond that, the circular says extra hospital charges caused by the delay are borne by the insurer.
Why is my cashless approval taking longer?
Common reasons are incomplete documents from the hospital, missing medical details, questions about pre-existing conditions or waiting periods, or the request being sent at a very busy time. The clock generally runs from when a complete request is received.
What should I do if approval is delayed?
Ask the hospital’s insurance desk for the request reference and time sent, then call your insurer or TPA quoting it. Keep notes of times and names.
This article is part of our complete guide to hospital costs in India.
This article is general information, not medical, legal, insurance or financial advice. Rules, schemes and hospital policies change, so always confirm details with your hospital, insurer or the relevant authority.