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The Insurance Times

(iii) Standardization initiatives on the non-medical expenses- Insurance
companies providing hospitalization indemnity covers generally exclude
certain categories of expenses in their policy terms and conditions. However,
as there is no detailed listing of such excluded expenses, and the interpretations
vary from people to people, many dispute arises between the insurance
companies, health care providers and the customers.

Hence initiative have been taken by the multi-stakeholders to come to a consensus
on the list of non-medical expenses to evolve an exhaustive list.

The aim of the Standardization of Treatment Guidelines (STG) are :
(a) Reduce claim disputes substantially by providing a reference framework for payers

to process medical claims for these conditions and thus reducing the needs for
queries moving back and forth between payers and providers.
(b) Enable increased automation of claims handling resulting in faster claim processing
and reduction of TATs for a significant proportion of claims.
(c) Help in setting appropriate grades/levels of payout for different types of surgeries
in fixed benefit plans and setting scientific and reasonable sub-limits for different
procedures in reimbursement plans.
(d) Provide a framework for costing and for development of appropriate price range
for these conditions in different situations.

166 The guidelines also provide the essential investigations which need to be carried
out in case of a particular condition, as also any specific additional ones, which
may be opted for in case of specified circumstances.

The guidelines also include a detailed discussion on implants or other surgical
consumables, including specific recommendations which meet quality expectations
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