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Few hospitals in the city offer cashless insurance facility
Small and medium hospitals have raised concerns over new empanelment and renewal of empanelment by insurance companies
PUNE The small and medium hospitals in Pune have raised several concerns over new empanelment and renewal of empanelment by insurance companies. The continual haggling between hospitals and insurance companies has drastically reduced the number of hospitals offering cashless facilities with several patients unable to get cashless treatment. There are four public and several private insurance companies offering mediclaim facilities with multiple packages. On top of that, these companies have appointed around 150 third-party administrators. However, it has decreased the number of small and medium hospitals offering the cashless scheme from 350 to 80 in Pune city, the doctors stated.
Dr Sanjay Patil, chairman of the Hospital Board of India, Pune chapter, said, the insurance companies have limited slots of empanelment with limited hospitals in one area for ease of business resulting in the trafficking of patients.
“They are trafficking patients, and this practice should be stopped at the earliest. Patients have the right to choose the hospital, which is not possible due to few hospitals offering cashless facilities. In many cases, the companies offer lesser amounts than what was approved during the claim settlement. In case of reimbursement, there is a delay from the companies and the hospital suffers as they lose the running capital,” he said.
The Hospital Board of India (HBI), Pune Chapter and Indian Medical Association (IMA), Pune Chapter have written several times to the insurance companies but to no avail. In India, patients seek doctor-based treatment and not hospital-based treatment. This also forces patients to take treatment only at corporate hospitals and end up paying huge amounts of money from pocket and their insurance coverage amount also gets exhausted soon, they claim.
Highlighting the same issues faced by multiple other hospitals across the country the HBI, a national body on December 5 wrote to the General Insurance Council stating the third-party administrators and ICS are pressurising the hospitals to accept non-viable packages they give and renew their Empanelment’s failing which they are being dis empanelment which is not a healthy trend being followed by them.
The HBI, India has requested the GIC to discuss issues like the empanelment of all the registered Hospitals, to work out and come out with a common Scientific Template with which Packages can be derived before empanelment. Also, representation of Associations in policy-making bodies of GIC, IRDAI, Common redressal forum where problems faced by each stakeholder could be brought up and solved.
Dr Ravindra Chajjed, head of Harsh Hospital, said, that despite several requests the hospitals are not getting empanelment or renewals. Even during the agreement, the rates given are not at par with the cost and the companies ask for discounts over the packages.
“The insurance companies are also stating that Copayment won’t be allowed due to which, hospitals are reluctant to start the cashless facility,” he said.
