Hospitals, insurance firms fight over new pricing and grading
The standoff between third party administrator (TPA) health insurance — using a mediator to process papers between hospitals and insurance companies — and the health sector seems to have taken a turn for the worse. Rhythma Kaul reports.delhi Updated: Aug 25, 2010 23:36 IST
The standoff between third party administrator (TPA) health insurance — using a mediator to process papers between hospitals and insurance companies — and the health sector seems to have taken a turn for the worse.
Terming the new prices arbitrary, most doctors running various hospitals and nursing homes in the Capital claim they were not involved at any stage while fixing cost of treatment and grading of hospitals.
"Such illogical cutting down of costs is ultimately only going to make people suffer, as it would mean cutting down on the quality of treatment," said Dr Mahipal Singh Sachdev, director, Centre For Sight, and secretary, Intraocular Implant and Refractive Society, India.
Dr Sachdev performs 500 cataract surgeries every month, which according to him has the second largest insurance claim after cardiac procedures. "A lens can cost anywhere between Rs 500 and 1 lakh…. We don't want a situation where we will not be able to offer superior quality lenses because we have to fit in the surgery in a particular budget," he said.
The Delhi Medical Association (DMA) also alleges that the prices were fixed without any consultation from its members. "It's a step clearly taken to benefit 'A' category hospitals. Prices of some procedures for the 'C' category hospitals are even lower than 50 per cent of what's fixed for 'A' category hospitals. It's unfair for people with small insurance cover, as for them, going to an 'A' category hospital would mean exhausting the entire insurance money in one go," said Dr Narender Saini, president, DMA.
"We provide quality service to people at their door step, so we should be given preference. How do they expect us to survive the competition?" said Dr V.K. Monga, chairman, DMA's nursing forum.
Since July 1, public insurance companies had removed a large chunk of private hospitals form the list of cashless treatment.
"There was no attempt made to keep any one out. All were invited to participate; some joined us, some didn't. It's unfair to say opportunity wasn't provided. Prices, anyway, have been still left for negotiation," said Dr Parvez Ahmad, CEO of Max Healthcare, who led the task force along with Pavan Bhalla, CEO of Raksha, Third Party Administrator, to analyse and come up with feasible ways to contain treatment cost.