Insurance cos push for uniform hospital rates

In a move to control health cover costs, insurance companies are bargaining hard with hospitals for a standard rate card. Market leader New India Assurance has told corporate customers that cashless repayment will be only to the point of the negotiated price and if any policyholder goes to a hospital, which charges more, the difference will have to be borne by the policyholder.

The TPA has asked corporates to ensure that their employees avail of cashless facility in these very hospitals. New India, which also has the largest health insurance portfolio, has set the ball rolling through its third-party administrator (TPA) Medi Assist. Medi Assist has spread to all group mediclaim policyholders a list of hospitals and the ‘reasonable charges’ levied by them for various procedures.

We shall restrict the settlement of the claim only to the limits indicated in the attachment and the employees shall be liable to meet the difference in the amount,” the TPA has said. “Should they avail the treatment for these procedures in any other hospital.

The rate card circulated provides a matrix of standard charges for secondary and tertiary providers in the premium and non-premium categories across various procedures. The tariff rates vary for metros where provision is made for higher costs.