Private hospitals in Punjab threaten to pull out of Sarbat Sehat Bima Yojana over tussle with insurance firm

Private hospitals in Punjab have threatened to pull out of the Ayushman Bharat-Sarbat Sehat Bima Yojana (AB-SSBY), alleging harassment at the hands of the insurance company implementing the scheme in the state

Private hospitals in Punjab have threatened to pull out of the Ayushman Bharat-Sarbat Sehat Bima Yojana (AB-SSBY), alleging harassment at the hands of the insurance company implementing the scheme in the state.

Private hospitals in Punjab threaten to pull out of Sarbat Sehat Bima Yojana over tussle with insurance firm

The Punjab chapter of the Indian Medical Association (IMA), which represents private hospitals in the state, said it may call for mass de-empanelment from the scheme as the company, Iffco-Tokio, which is settling claims, is unnecessarily imposing hefty penalties on its members.

Nearly 200 private and 250 government hospitals in Punjab are empanelled under the scheme. On the recommendations of the company, the state government has already de-empanelled 24 private hospitals from the scheme, citing discrepancies.

“There is a strong resentment against the company. In the name of verifying our claims, the firm’s vigilance team checks our infrastructure and then imposes heavy penalties on us. We are planning to pull out of the pact if the state health minister doesn’t intervene immediately,” Dr KD Singh, president of IMA, Punjab chapter, said.

An IMA delegation has also sought audience with health minister Balbir Singh Sidhu, he added.

The AB-SSBY was launched in August 2019 as a flagship health insurance scheme in the state. The Amarinder Singh-led Congress government extended the benefits of the Centre’s Ayushman Bharat which was to cover nearly 14 lakh families as per the Socio-Economic Caste Census (SECC) data. The premium for 14.65 lakh SECC beneficiary families shall be borne by Centre and the state in 60:40 ratio. The premium cost of remaining 16.49 lakh beneficiary families will be completely borne by the state.

The Association of Nursing Homes, Jalandhar, in a meeting earlier this week, has also threatened to drop out of the pact signed by private hospitals, the state government and the insurance firm.

“As per the MoU, the company’s vigilance team should be headed by a managing director or a retired director-level senior health official. But their teams are headed by BDS or BAMS doctors,” said Dr Dheeraj Gupta of the association.

IMA national vice-president Dr Navjot Dahiya said the private company officials have turned inspectors checking established hospitals to tarnish their image. “If there is an issue between a hospital and the insurance firm, the state health agency does not have powers to adjudicate the dispute,” said Dr Dahiya.

Iffco-Tokio project head (Punjab) Dhritman denied the allegations, saying it is the right of the company to check infrastructure and audit treatment cost per the MoU.

“There is no question of harassment. Whatever action we take is decided by a committee of experts headed by the secretary (health). Moreover, a penalty is imposed only after a couple of hearings for the hospital to clear objections,” he said.