Mumbai: Hospital associations have rejected the General Insurance Council (GIC) advisory on admissions for fever and infectious diseases, saying they will continue to admit patients based on doctors’ clinical judgment rather than the insurer-backed guidance.
GIC, however, said advisory is only a non-binding note based on government treatment protocols and will not determine claim decisions.
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.
The Association of Medical Consultants also rejected the advisory, saying while doctors already follow guidelines of the Indian Council of Medical Research (ICMR), GIC’s stand could become a basis for rejecting genuine claims, particularly reimbursement claims involving individual policyholders treated at smaller hospitals.
“The decision to admit a patient for fever or other reasons should be left in the best hands of the doctors and the General Insurance Council should stay out of it,” said Girdhar Gyani, director general of AHPI.
He said hospitals had proposed an Insurance Redressal Forum to address disputes with insurers and would oppose any rejection of claims based on the advisory.
Sudhir Naik, trustee of the Association of Medical Consultants, said the ICMR guidelines were already being followed by doctors and the concern stemmed from GIC formally adopting them.
“These guidelines are nothing new. Our concern is that by becoming a GIC advisory, they could become a tool for arbitrary rejection of genuine claims, especially reimbursement claims from individual policyholders patronising smaller hospitals,” he said.
GIC, however, has said the advisory merely reiterates treatment guidelines issued by the ICMR, the Ministry of Health and Family Welfare and the National Centre for Vector Borne Diseases Control.
“These are not guidelines created by insurers,” said S Prakash, chief executive of the GIC’s Health Insurance Committee. He said the advisory was issued in the larger public interest and was not a rule.
GIC also rejected concerns that the advisory would be used to deny claims. “The advisory does not determine claim decisions. It simply reiterates treatment protocols already issued by government medical bodies,” Prakash said.
GIC said health insurers settled claims worth ₹94,247.6 crore in 2024-25, of which cashless claims accounted for 66.4% of the total. It added that admissions for minor fever, unnecessary investigations and prolonged hospital stays have risen in recent years.
R V Asokan, former president, Indian Medical Association, said clinical decisions should be guided by doctors and professional medical bodies rather than insurers.
“The insurance industry has no role in deciding clinical care. It has a conflict of interest,” he said, adding that everything begins as an advisory and the fear is that it could eventually influence hospitals’ admission decisions.
