Hope rises for cashless insurance beneficiaries

Times of India

PUNE: A solution to the problem of cashless facility for medical insurance is likely in a week. Union minister for environment and forests Prakash Javadekar, on Friday, who met representatives of hospitals' associations, consumer bodies and insurance companies, said a finance ministry expert will be roped in to clear the issue. 

Public sector insurance companies have asked private hospitals in Pune and Pimpri Chinchwad to stop offering cashless treatment facility to individual policy holders, but big hospitals have been asked to continue with the facility for corporate policy holders. 

"An expert from the finance ministry will meet the stakeholders and find a solution . At present, cashless facility for medical insurance offered by public sector insurance companies is available only at 40 hospitals in Pune. We will see how we can expand its base and involve more hospitals," Javadekar said at a news conference after the meeting. 

Orthopaedic surgeon Nitin Bhagali, president of the Association of Hospitals, Nursing Home and Clinic Owners of Pune, and a member of the hospitals' committee of the Indian Medical Association, Pune chapter said, "We are opposed to the idea of classifying hospitals on the basis of infrastructure. Instead, expertise, seniority and the bio-data of doctors should be given more weightage in deciding the rate list for various procedures." 

The association is also opposed to the current practice of offering different rates to different hospitals for the same procedures, he added. 

"There should be uniformity in the rates and the rate list should be finalized in consensus with the stakeholders. The whole process should be absolutely transparent. The Union minister was surprised when we told him about the rates disparity. He said experts from the All India Institute of Medical Science (AIIMS) should be roped in to finalize the rate list," Bhagali said. 

When the minister asked an insurance company representative how the rate list is prepared, he was told public sector insurance companies study the reimbursement claims and prepare the rate list without involving experts from government hospitals, he added. 

An insurance company official said Pune was among 11 cities where the preferred providers' network is implemented to keep a check on unnecessary expenses that hospitals charge when a patient is insured. "The current uproar in Pune is uncalled for. The system is running smoothly in other cities. The rates are different in metros and non-metro cities. Pune is under non-metro category, hence the rates are lesser than what they are in metro cities," he added. 

Public sector insurance companies like New India Assurance Company, United India Insurance Company, Oriental Insurance Company and National Insurance Company, under the banner of General Insurance Public Sector Association (GIPSA), sell nearly 80% of the health insurance policies in the country. They had floated fixed rates in metros three years ago and are now extending it to Pune and other two-tier cities.