Recently, we came across news in an online Publication, business-standard.com
The decision by public sector health insurance companies to deny cashless services to their clients has been criticised by Fortis, a leading corporate healthcare chain.
Chains such as Fortis generate a significant portion of their revenue through health insurance policy reimbursements.
The Federation of Indian Chambers of Commerce and Industry was also critical. Pointing out that private insurance firms are managing to offer cashless services to policy holders, it wanted public sector firms to review their decision to suddenly withdraw this facility. “Withdrawal of an important component of a financial contract without sufficient notice is not fair and just,” it said. National Insurance Co Ltd, New India Assurance Co Ltd, Oriental Insurance Co Ltd and United India Insurance Co Ltd have said many leading hospitals are charging exorbitantly for treatments offered to insurance-protected patients. The hospitals say the problem is not with their fare structure, but with the policy packages offered by the insurance firms.
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Experts from Medimanage.com give their opinion:
Though there are cases of inflated billing from hospitals, that’s not the sole reason for higher claims. An Hernia is a secondary care surgery but often, insurance patients get this done in Tertiary care hospital because there is no norm that restricts the person from not visiting such hospitals. The normal cost of 30-35 K goes up to 60-70K because the overheads of such hospitals are higher. This generally inflates the cost but cannot be termed as wrong-doing by the hospital.
The higher claims ratio has two components: One is Premium & the Other is claims. For better claims ratio, the correct premium pricing is also an important factor. The way the premium pricing is done currently is also faulty & hence, that’s an area which needs to be looked into too.