Till last year, the Punjab government employees and pensioners could get treatment from any hospital and claim reimbursement. This year, after the government replaced that system with cashless health insurance, they are sick of harassment.
Even empanelled hospitals complain of delayed settlement of claims and reduction in assessed cost of surgery without intimation. Punjab Government Pensioners Joint Front leader Mohinder Singh Parwana told HT that delayed authorisations that held back treatment were order of the day.
Many hospitals have even charged patients full treatment cost, based on a false promise of repayment once the insurer settles the claim. “The state health department is sitting on two of these complaints filed last month,” said Parwana. Jalandhar patient Sushil Kataria claimed that he was entitled for treatment worth Rs 3 lakh under this scheme but forced to pay Rs 85,000 for surgery to a local hospital that had declined to deal with the government insurer, claiming it was bad with giving approvals. Still waiting for the reimbursement, he said “the earlier system of clearing bills based on entitlement was better”.
The scheme launched on January 1 and outsourced to Oriental Insurance has nearly 4 lakh subscribers, most yet to receive their e-cards, guidebooks, and list of empanelled hospitals. India Medical Association’s Punjab chapter senior executive Dr Rajinder Sharma said hospitals alone were not to blame. “About 40% of the empanelled hospitals are eye centres, all irked by the insurer’s new approved cost of cataract surgery — down from Rs 10,000 to Rs 6,000 without notice. “A quality cataract operation can’t be done in this meagre amount,” he said.
Another issue is the delay in settling claims. “Corporate hospitals can absorb the pressure, as their immediate aim to increase the footfall. Small health enterprises, however, can’t afford two-to-three-month delay in payment when the settlement period is 30 days under the scheme,” Dr Sharma added.
Asked to react, Vipan Sharma, project director in Punjab Health System Corporation, said the insurance company had blamed the delays on a software glitch. “In the past five months, we have settled most of the 300 complaints we received, with action against some of the empanelled hospitals. That the insurer has settled claims worth more than Rs 70 crore reflects the success of the scheme,” he said.
“I don’t claim there are no teething problems but we are bound to take corrective measures, review the policy, and seek feedback from stakeholders for constant improvement,” said the project director.
All employees and pensioners now are required to enrol under the Punjab Government Employees and Pensions Health Insurance Scheme (PGEPHIS) that was earlier optional, on the lines of the benefit extended to all-India-service officers; serving and former legislators; and past and present judicial officers, including the Punjab and Haryana high court judges.
“The state government has double standards. If this scheme was good for all employees, why only a certain class has the choice of remaining in the old system?” asked Sangrur private medical practitioner Dr Amandeep Aggarwal.
Launched on: January 1
Outsourced to: Oriental Insurance
Subscribers: 4 lakh, most yet to receive their e-cards, guidebooks, and list of empanelled hospitals