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Cashless medical aid row drags

Patients in Mumbai will have to wait before availing the benefits of cashless hospitalisation as negotiations between health insurance companies and hospitals remain deadlocked over pricing.

india Updated: Jan 31, 2011 22:47 IST
Mahua Venkatesh

Patients in Mumbai will have to wait before availing the benefits of cashless hospitalisation as negotiations between health insurance companies and hospitals remain deadlocked over pricing.

This is contrary to other cities where most hospitals in Delhi, Bangalore and Chennai seem to have struck a consensus on the pricing of various ailments that need hospitalisation.

“It will take some more time to strike a consensus in Mumbai,” an industry source told Hindustan Times.

“The issue is yet to be resolved and the worst impacted are the ones who have valid policies,” the source said.

Industry estimates suggest Indians spend an estimated $35 billion every year on healthcare.

Corporate hospitals such as Max, Apollo and Fortis, however, have decided to opt for reimbursement policy and stay out of the list of preferred provider network (PPN).

In July last year, the state owned general insurers New India Assurance, United India Insurance, Oriental Insurance, and National Insurance Company had stopped cashless services for policy holders in some of the corporate hospitals.

In a bid to iron out differences, public insurers in September 2010, had asked corporate hospitals to come up with discounted rates for 42 medical procedures covering almost all ailments requiring hospitalisation. While some hospitals have submitted their rates, others are yet to do it, the person added.

After several rounds of hectic confabulations, hospitals and insurance companies hammered out mutually acceptable pricing formulae for a list of ailments restoring cashless facility for insured patients.

These hospitals stayed away from the list of PPN worked out by insurance companies in wake of the impasse of the cashless hospitalisation, on grounds that these are super-specialty hospitals. Patients, especially the senior citizens, have been the worst impacted and said that there is a cause for concern with the comfort of cashless hospitalisation not being there.

Insurance companies have started re-pricing the existing policies. The premium rates for most health insurance products have gone up. In case of group insurance, the pricing is based on claim ratio trends of a particular company, a source said.