Public Leaderboard Methodology & Right-of-Reply
1. Objective & Statutory Safe-Harbor
The Hospital & Insurer Transparency Index published on reclaimbill.com is an informational, consumer-advocacy utility. Its sole purpose is empowering distressed policyholders to understand historical deduction patterns and turnaround times across Indian network hospitals.
In accordance with Section 356 of the Bharatiya Nyaya Sanhita, 2023 (and Section 499 of the Indian Penal Code), statements of factual data made in good faith regarding public conduct or public administrative decisions—specifically healthcare billing under public IRDAI regulations—enjoy full statutory safe-harbor protection.
2. Data Sources & Neutral Aggregation
All statistics displayed on the leaderboard are derived from neutral, verifiable data streams:
- Council for Insurance Ombudsmen (CIO) Awards: Publicly available rulings and awards published by CIO centers across India under the Insurance Ombudsman Rules, 2017.
- Anonymized User Audit Sessions: Aggregated, non-personal mathematical metrics submitted by policyholders during bill audits.
- Strict Zero-PII Aggregation: Before any statistical datum is recorded in the macro index, automated regular-expression scrubbers strip all policyholder names, doctor names, invoice numbers, policy numbers, and 6+ digit identifiers.
3. Core Leaderboard Metrics Explained
1. Observed Provisional Deduction Variance (%)
Calculated as the percentage difference between the total initial hospital bill amount and the provisional cashless approval issued by the TPA before policyholder discharge. This indicates the average proportion of the bill initially disputed or subjected to non-payable deduction.
2. Average Reported Cashless Authorization TAT (Hours)
The elapsed time from when the final hospital discharge summary was transmitted to when the TPA/insurer issued final cashless clearance. The IRDAI Master Circular 2024 (Clause 6.1) mandates a strict 3.0-hour turnaround time (TAT). Delays exceeding 3 hours are statistically flagged.
3. Primary IRDAI Violation Categories
Common statutory rules triggered during audits, including Clause 19 (illegal proportionate room-rent deductions on MRP implants and pharmacy), Annexure-1 (unlawful surgical consumable deductions with active rider), and unapproved hospital administrative/MRD fees.
4. Institutional Right-of-Reply & Data Correction Mechanism
We are committed to absolute factual precision and fairness. Any accredited hospital network, medical superintendent, TPA claims officer, or insurance company representative may exercise their institutional right of reply:
- Submission Procedure: Send verified cashless turnaround logs, Preferred Provider Network (PPN) tariff revisions, or formal factual corrections to support@reclaimbill.com with the subject line "Institutional Right-of-Reply - [Hospital/TPA Name]".
- Review Turnaround: Our legal and data compliance desk reviews institutional submissions within 72 business hours.
- Profile Update: Verified corrections and official right-of-reply statements will be appended directly to the respective institutional scorecard profile.
5. Operating Entity & Official Contact
- Legal Entity Name: ReclaimBill
- Operating / Registered Address: Shivrana chauk, Kuwe, Shirpur, Maharashtra- 425427, India
- Customer Support & Right-of-Reply Desk: support@reclaimbill.com
- Helpline Phone: +91-7981975105
- Operating Hours: Monday to Friday, 9:00 AM – 6:00 PM IST