Several hospitals have restored the cashless treatment facility for patients insured by four public sector insurance companies, though some of the larger ones, like Max Hospitals, are yet to follow suit. Bulk of the hospitals have restored cashless mediclaim facility, which was suspended from July 1, for people insured with public sector general insurance companies, insurance industry sources said.
However, some of the large hospitals like Max, Apollo and Fortis have not restored the facility as they are yet to reach at an agreement on the package rate structures with the PSU insurers. When contacted, Max Healthcare CEO and MD Pervez Ahmed said, "We have given our rates to the PSU insurers about 3 weeks back. We have not received any communication from them."
Apollo and Fortis could not be reached for comments. Medanta CMD Naresh Trehan confirmed that cashless facility has been restored in the Medicity. "We have reached agreement with the TPAs and the facility has been restored earlier in the week," he said.
The Third Party Administrators (TPAs) are facilitators between the insured and insurers. From July 1, the four state-owned companies -- New India Assurance, United India Insurance, National Insurance and Oriental Insurance —- had stopped providing cashless facilities at select hospitals in cities such as Delhi, Mumbai, Chennai and Bangalore on grounds of over-billing by certain private hospitals.
The general insurers have since reworked their lists, retaining only those hospitals that have agreed to their packaged rates for various medical treatments. At present 449 hospitals are covered under the cashless network, called Preferred Provider Network (PPN), of the four insurance companies. After a series of meeting to resolve the impasse, the two parties had agreed to categorise the hospitals on the basis of infrastructure availability and benchmark rates accordingly. High-end hospitals including Apollo, Fortis later agreed to restore partially the cashless facility for accident, trauma and intensive care centres. The state-run insurance companies are currently paying paying 40 per cent more than the premiums collected in claims.
Public sector insurance companies had to resort to rationalisation of rates for cashless facilities as they suffered a loss of Rs 2,000 crore because of overcharging by hospitals.