Insurance firms, hospitals slug it out, patients suffer

The tussle between public insurance companies and corporate hospitals in the city is turning out to be a nightmare for medical insurance holders entitled to cashless treatment. Rhythma Kaul reports.

The tussle between public insurance companies and corporate hospitals in the city is turning out to be a nightmare for medical insurance holders entitled to cashless treatment.

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Big private hospitals in the city are receiving as many as 10 denials per day from public insurance companies for pre-sanctioning of cashless treatment facility. All are for individual, not corporate claims.

"On July 1, we received the first cancellation for a cancer patient. Since then, we have been getting as many as 10 denials per day," said Sanjay Rai, director, marketing and customer management, Max Healthcare.

Insurance companies said they were forced to withdraw the cashless facility because many private hospitals overcharge patients with insurance.

"Expecting private hospitals to provide treatment at CGHS rates is irrational," said Dr Sanjeev Bagai, chief executive officer, Batra Hospital.

"What's the point of paying premiums for a cashless policy if we have to pay during an emergency? " said Vikas Pawar, a software engineer, whose father's knee replacement surgery had to be postponed.

In an effort to end the impasse, the Confederation of Indian Industry (CII) organised a meeting between corporate hospitals, such as Apollo and Max, and four public sector undertaking insurance companies — New India Assurance, Oriental Insurance, United India Insurance and National Insurance Company, and General Insurance Public Sector Association in Mumbai on Tuesday.

"In next one week, the Third Party Administrators will individually meet big healthcare providers in the country to discuss the finer financial details for restoration of the cashless treatment facility," said A. Vaidheesh, chairperson, CII sub-committee on accessibility, health insurance and the medical industry.

The CEOs and heads of about 15 private Delhi hospitals will meet on Wednesday to look for a temporary solution. Till the time cashless treatment facility is restored, people will be reimbursed their medical expenses.