No cure yet for cashless medical claims impasse

The Association of Hospitals, which represents most private hospitals in the city, has asked health insurance providers to offer cashless medical insurance claims to patients at all hospitals till the differences between the two groups are resolved. The root of the tussle lies in the long standing allegation that hospitals overcharge patients with cashless medical insurance. Since it’s the insurance firms that foot the bills, the patients don’t protest and the hospitals make a killing.

It’s the insurance firms that are left bearing the loss. Public insurance firms, such as New India Assurance, suffer an estimated annual loss of Rs 300 crore each because of such inflated bills.

On July 9, public health insurance companies retaliated by slashing the list of hospitals in Mumbai that could offer cashless medical insurance benefits.

From the 800 hospitals in ci that could offer the facility earlier, now only 81 feature on a new Preferred Provider Network (PPN) list drawn up by insurance companies.

“A solution will take time. Meanwhile, cashless medical claims should be offered to all hospitals so that patients don’t suffer,” said Pramod Lele, CEO of P D Hinduja Hospital.

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Experts from Medimanage.com give their opinion:

Sudhir Sarnobat:

Sudhir Sarnobat from Medimanage.com

The hospitals have realised that they also need the insurance companies for their top line as the share of revenue thru insurance vis-à-vis the self-paying is growing & not negligible anymore.

However, a third party negotiation (like government) will not help as the insurance companies do not wish to control the actual healthcare delivery mechanism but would like to have a say in the cost of care (only when the patient is going thru insurance plan).

Insurance companies should demand the financials which should also include costing methodology of these hospitals (any vendor accreditation program by a large customer always follows these practices) & after through scrutiny of the same, they should bring out their demand of price tariffs for various procedures. This would be a fair process for ending this imbroglio.