IRDA on Health insurance cashless dispute

The Insurance Regulatory and Development Authority (IRDA) Friday said the issue of offering cashless treatment under health insurance policies issued by the four government-owned general insurers 'is getting resolved'. IRDA Chairman J. Hari Narayan said that prior to dispute there were only 300 government owned insurers as compared to 400 now.
The four government-owned non life insurers had earlier delisted major hospital chains from offering cashless hospitalization facility for their health insurance policy holders on the ground that the hospitals are over charging the patients.
He was in Chennai to launch the country's first health cum life insurance product introduced by the city-based Star Health and Allied Insurance Company Ltd partnering with private life insurer Shriram Life Insurance Company Ltd. when he clarified.
There are talks of creation of separate regulator for the healthcare sector. Also, Confederation of Indian Industry (CII) has said none of the major super speciality hospitals have signed with the Raksha TPA (third party administrator).
CII’s members are waiting for a response from the insurers and the TPA since the meeting Raksha in Delhi. As on August 12, the hospitals in Delhi have worked out the packaged rates for 42 procedures and submitted to the TPA.
Once cashless is restored in the empanelled hospitals, in the second phase, hospitals and insurers along with other stakeholders of the health insurance ecosystem and the competent authority would work on a classification of hospitals, which would be agreeable to all.

The other side:

Shivinder M. Singh, managing director, Fortis Healthcare said 'There will always be a differential in the levels of care and services provided by hospitals for a single type of illness. This differential is a function of structures, processes and outcomes. A scientific analysis of all these parameters is essential to grade hospitals.'
Sanjeev Bagai, CEO, Batra Hospital and Medical Research Centre said, 'This grading or categorization of hospitals should then translate into pricing of procedures in each grade. Premature conceptualization or inference of this complex process must be avoided'. It is essential that a comprehensive exercise be undertaken of grading hospitals based on their infrastructure, clinical expertise, technology base, clinical outcomes, competency of para-clinical man power, accreditation and standards of care is done.

Cashless hospital cover possibly will come back in a week

Corporate hospitals may restore cashless treatment to policyholders of the four public sector health insurance firms in a week.
Such hospitals as Apollo, Fortis, Max and Medanta will negotiate new package rates with individual third party administrators (TPAs) and arrive at an agreement in the next five to six days, a meeting of the representatives of leading private healthcare chains and the nodal TPA of the public sector undertaking insurance firms decided here today. Delhi-based Raksha TPA represented the insurance industry in today’s talks.
The TPAs are the facilitators between the hospitals and health insurance firms like New India Assurance, United India Insurance, National Insurance and Oriental Insurance.
Pervez Ahmed, managing director of Max Healthcare, who heads the hospital delegation on behalf of industry chamber Confederation of Indian Industry’s National Healthcare Committee, said the decision would be an interim one and a comprehensive agreement will be ready within a month.
He hinted that policyholders might have to pay different levels of premium, depending on the hospitals one opts for treatment.

Pvt hospitals get together insurance firm today

Leading corporate hospitals, which are out of the preferred provider network (PPN) of public sector health insurance firms, will offer standardized treatment packages for nearly 250 procedures to see their PPN status restored soon.
The representatives of hospital chains such as Apollo, Fortis and Max are expected to meet their health insurance counterparts with the new proposals tomorrow.
The move comes after a recent meeting of the heads of the hospitals and the four state-run insurance firms — New India Assurance, United India Insurance, National Insurance and Oriental Insurance — decided to form separate working groups to sort out the pricing issues the insurance firms had with these hospitals.
The groups were expected to sort out a compromise formula within 10 to 30 working days.
The insurance firms had stopped offering cashless services to their policy holders approaching the hospitals that are not in their PPN list as they felt that such hospitals were ‘over charging’ their insured patients.
The hospitals, grouped under industry chambers such as CII and Ficci, had argued that isolated incidents should not be the basis for excluding corporate hospitals from PPN.
“The insurance companies had never raised such an issue before. Now that they have expressed their concerns, we will try to address their problems. Tomorrow’s meeting will not be the final one, but we expect most of the current issues to be solved soon,” a healthcare industry executive, who is part of the negotiations, said today.
The high claim ratio — health insurance claim ratio stood at 130 per cent during 2009-10 — was the main reason for the insurance firms to have a strict scrutiny of the rates being charged by the hospitals for various procedures.

Hospital corpse to clarify position on cashless medical insurance

The Association of Hospitals, which represents most private hospitals in the city, will on Wednesday simplify its stand on the issue of cashless medical insurance. Many insurance holders had been left in the pitch as public sector insurance companies had determined to limit cashless mediclaim policies to only those hospitals that characteristic in the favorite Provider Network list drawn up by them.
This covered only 81 hospitals in Mumbai.
The public sector companies had done this saying the hospitals were billing patients advanced if they came under mediclaim.
The companies want hospitals to stay to a set of standard rates for surgeries and medicines.
“Hospitals are being asked to conduct bypass surgeries for Rs 1.8 lakh, which is not likely in a city like Mumbai,” said General Vijay Krishna, chief executive officer (CEO) of Breach Candy Hospital, who is a member of the association.
“The insurance companies are also saying they will buy equipment and medicines straight and give to them hospitals,” he added.
“This is just not practical. If we need some equipment immediately, will we have to wait till it is sent to us.”
“The insurance companies should have held a discussion with us before making such decisions. We have not been given a consideration,” he added.