E-Paper
Patients face inconvenience to avail cashless insurance facility
The low rates offered to non-network hospitals and the discrepancy in the amount received compared to the approved amount have made hospitals reluctant to provide cashless everywhere service, hospitals claim
Insured patients in the city face difficulties accessing the benefits of “cashless everywhere,” an ambitious initiative launched by the General Insurance Council (GIC). The low rates offered to non-network hospitals and the discrepancy in the amount received compared to the approved amount have made hospitals reluctant to provide cashless everywhere service, hospitals claim.
In January this year, the GIC launched the “cashless everywhere” initiative. The Insurance Regulatory and Development Authority of India (IRDAI) also issued the ‘master circular on health insurance products’ in June and asked general/health insurers to offer a wider range of products to customers, including those with all types of existing medical conditions and pre-existing diseases and chronic conditions.
The Indian Medical Association (IMA), Pune chapter and Hospital Board of India (HBI) of the Pune chapter claim there is a need to change the offered rates and unnecessary deductions to avoid inconvenience to patients and doctors. A rate list has been made and will be provided to GIC, IRDAI and all insurance companies, both private and government insurance companies.
Dr Sanjay Patil, chairman, HBI, Pune chapter, said, “Due to such type of deductions and low payments, the hospitals cannot compromise on the quality and safety of patients. Also, it is written in the contract, kindly do not collect any difference money or co-payment from the patient.”
A patient relative, on anonymity, said, “My father was recently admitted at a private hospital in Hadapsar for appendectomy and the estimated treatment cost of ₹1.25 lakh was sent to the insurance company. The amount approved was ₹1 lakh and we were ready to pay ₹25k from pocket. However, during releasing the payment the insurance company paid ₹40k to the hospital.”
Dr Aniket Joshi, member, IMA Pune Chapter, said, “Even after having nursing home registration the hospitals have to apply separately to insurance companies for empanelment. The empanelment is done on the wimps and fancies of the insurance companies. To make cashless everywhere successful the government should ask insurance companies to give blanket approval to hospitals registered under the Nursing Home Act. Also, the co-payment option should be made available.”
The hospitals are asking patients to pay the money for treatment and get reimbursement from the insurance company. Besides, there is no grievance redressal for the hospitals unlike patients for cashless everywhere.
