Insurers to settle row with hospitals
July 30: Cashless health insurance facility may be restored within 30 days. The state-owned health insurers and major hospitals on Friday decided to form a working group to try to arrive at a common understanding on packages for treatments within 30 days. “The 30 days is outer limit but we are making an effort to find solution in next 10 working days,” said Dr Naresh Trehan, CMD of Medanta and chairman of CII national committee on healthcare.
He said that insurance companies have partially restored the cashless facility for emergency, ICU, cardiac care and trauma. From July 1, public sector health insurance companies, which have around 70 per cent market share, had stopped cashless facility at several large hospitals. Insurers claim that hospitals are misusing this facility and overcharging their customers. The insurance companies had alleged that for the same treatment, the hospitals were charging more if the customer was paying through cashless facility. The insurance companies had also capped the amount a policy holder can claim for a treatment. Health insurance companies are facing problems as the overall money gone for claims was 30 per cent more than premiums received in a year.
“We — insurance companies and hospitals — are together in our effort to provide best care to the patient at the best affordable price,” said Dr Trehan. He said that the action group will study issue from both sides and come up with solutions. The proposal will later on put before the heads of insurance companies and hospitals for discussion and reaching a final conclusion.
LEARN WITH DC
Q What is the dispute between insurance firms and hospitals?
Starting from July 1, public sector health insurance firms have withdrawn the cashless facility at several large hospital chains. Insurers claim that hospitals are misusing this facility and are overcharging customers. Companies have also capped the amount that a policy holder can claim.
Hospitals say that costs in large super-speciality clinics differ as they provide high end services. They also say that input costs have gone up because as staff salaries have risen.
Q What was the impact?
For the common man, withdrawal of cashless facility was a problem as without it he had to pay for the hospital treatment from his pocket and latter on make a claim with the insurance companies. This is a major inconvenience. There are about eight crore mediclaim policy holders in the country.
For large hospitals, no cashless facility meant loss of business as many consumers can’t afford their costly services. For health insurance companies the controversy means a loss of credibility.
Q Which were the cities where insurers withdrew the cashless facility?
The cashless facility was stopped in major hospitals in metros such as Delhi, Mumbai, Chennai and Benguluru.
Post new comment