31 July 2010
By Manthan K Mehta
Mumbai, India
TAKE CARE
Meanwhile, after PSUs came up with new rates for cashless mediclaim–for instance, they will not pay over Rs 23,000 for a cataract surgery–city ophthalmologists have decided not to carry out surgeries under the cashless scheme. Dr T P Lahane, president, Bombay Ophthalmic Association, said, "The rates offered by PSUs are much lower than the actual cost incurred on eye surgeries.Even government hospitals cannot limit the expenditure to the rate fixed by insurance firms.’’
Insurers seek rate card from hosps PSU Cos Set Deadline For 4 Healthcare Chains To Come Out With Cashless Packages
New Delhi: There seems to be no immediate end to the standoff between insurance companies and private hospitals over cashless treatment.
Four public sector health insurance companies, which control 80% of the mediclaim business, have now set a 10–day deadline for four major chains of hospitals – Apollo, Fortis, Max and Medanta – to come out with their packages for common treatments to avail of cashless services.
The tough talking by PSU insurers – National Insurance Company, New India Assurance, Oriental Insurance and United India Insurance – came after month–long negotiations failed to bring these hospitals on board for standardised treatment packages.
These hospital chains, along with 100–odd other hospitals in Delhi NCR and Mumbai, Bangalore and Chennai, had been taken off the network of hospitals for cashless services on July 1. The withdrawal of cashless service was a delayed action against hospitals which were allegedly overcharging for treatment.
On Friday, the four PSU insurers met CEOs of the four major hospitals in the Capital and set up a committee comprising chief of Max Hospital chain and CEO of Third Party Administrator to devise packages for common treatments.
Addressing a gathering of insurers and hospital chains at Ficci, IRDA chief J Hari Narayan said there need to be a regulatory mechanism in place to address complaints of overcharging by hospitals. He said at present this was beyond IRDA’s domain.
The IRDA chief lambasted "5–star hospitals’’ for inflating bills and justifying their costs in the garb of quality service. Hari Narayan said if a treatment costs $50,000 in the US and the same comes for $5,000 in India, the latter cannot be termed inferior simply by the difference in their costs.
His remarks came in response to Shivendra Mohan Singh of Fortis chain who said insurers could not make a common package and club 50 hospitals all providing different quality of services.
The IRDA chief said his information bureau, where all mediclaim reports were archived, showed that while average charges for a medical procedure under the reimbursement category was Rs 25,000, it went up to Rs 33,000 under the cashless scheme. This showed how hospitals inflated bills at the cost on insurance companies.
Hari Narayan said if there are any breach of contract between insurers and policyholders, IRDA will take penal action immediately. Briefing media on a CII platform, Naresh Trehan of Medanta said cashless is not a major issue though "we have restored this facility for emergency, trauma and all ICU admissions for all customers." But, as opposed to IRDA chief, he was against a health regulator.
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