Max, Apollo, Fortis stay off insurance network
Corporate hospitals such as Fortis, Max and Apollo have stayed away from the list of preferred provider network (PPN) worked out by insurance companies in wake of the impasse of the cashless hospitalisation, on grounds that these are super-speciality hospitals.
"It is almost two months since we submitted our set of rates to the insurers but they have not reverted, we could not agree on the rates of 11 surgeries out of the 42 odd procedures," Pervez Ahmed, CEO and managing director, Max Healthcare told Hindustan Times. "In case of some of the surgeries, our rates are lower than the rates fixed by the insurers," he said.
Insured patients are currently being offered reimbursement of bills.
Patients, especially the senior citizens, have however said that this is a cause for concern with the comfort of cashless hospitalisation not being there.
Industry sources said that this is not an unusual development. The Insurance Regulatory and Development Authority (IRDA) has also said that the PPN list is dynamic and subject to change from time to time. However, the regulator has said that any change in the list must be informed to policy holders much ahead of the withdrawal. The insurers have also been asked to provide the names of the nearest alternative options and the conditions that apply there.
Most insurance companies have quietly started raising the premium rates alleging that hospitals have been inflating bills. Even for group insurance, pricing is based on claim ratio trends of a particular company.