Notes on health-insurance claims and audit

Short notes on how Indian health-insurance claims are processed and audited, each tied to a worksheet, with the source and how well it is sourced.

• Does a query stop the TAT clock? One file, two answers 1 November 2026
  One invented cashless file, timed two ways: with the clock running straight through it is late, with a pause for the hospital’s reply it is on time. What the circular says, and what practice does.
• Proportionate deduction, explained with a worked example 1 November 2026
  How a room-rent cap can reduce more than the room line: the ratio, the expenses it applies to and the ones it leaves out, on an invented bill with every rupee shown.
• Why a cashless approval takes longer than an hour, and who is holding the file 1 November 2026
  What IRDAI says about the one-hour limit for cashless approval, whether a query stops the clock, and the points where a file waits, from hospital to doctor.

Every case on this site is synthetic. These are working drafts and illustrations, not a claim decision or legal advice. The interactive worksheets need JavaScript; nothing is sent anywhere.