Are uniform rates for Medical procedures plausible for Insurance Claims?

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Cashless mediclaim policy Pvt hospitals seek government help

The association of private hospitals have sought state government’s intervention to settle the ongoing dispute with insurance companies over cashless mediclaim policy.

The association, which includes hospitals like Jalok, Breach Candy, Hinduja and Hurkisondas, has said that the demands of uniform rates for medical procedures that had been put forth by insurance firms were not plausible. “Rates differ according to available equipment and location of hospitals. Even within hospitals, rates vary according to the class of service patients opt for,” said CEO of Jaslok Hospital Colonel Manesh Masand. He added that costs also vary for different procedures for the same ailment. “Cancer can be treated by focused MRI and through surgery, at exponentially different costs. The choice of treatment is finally up to the patient,” said Colonel Masand.

“Government intervention is required here. Petrol is being made duty free, whereas hospitals have to pay the highest custom duties for all imported equipment. It is important to understand that our costs are determined by all these factors,” said Breach Candy Hospital CEO Major General Vijay Krishna.

The hospital authorities also rubbished allegations of overcharging. “The billing system in private hospitals is fixed and freely available for all patients to see in advance. Where is the room for exceeding the set charges for particular procedures?” said Pramod Lele, CEO of Hinduja Hospital.

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Experts from Medimanage.com give their opinion:

Sudhir Sarnobat:

Sudhir Sarnobat from Medimanage.com

As debated earlier, it’s important to have the tertiary care hospitals in the network too. The ratio should be 10% Tertiary care Hospitals, 30% Secondary care Hospitals & 60% Primary Care hospitals. This would also mirror the percentage of claims for ailments that are similar.

It’s true that the cost of equipment, land & infrastructure are high for big hospitals & the same will reflect in the overall billing pattern of the hospitals. The health insurance companies must make up their mind on what is that they wish to execute as reforms & then only this deadlock can be resolved in amicable manner. Till such time, allegations & counter-allegation would continue.

The entry of state government may not help as government has not been efficient in healthcare delivery before & the issues involved here are beyond the govt. official’s domain expertise.

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