Hospitals-insurance firms standoff continues

As hospitals and insurance companies bicker over cashless mediclaim, patients are suffering.

New India Assurance, United India Insurance, National Insurance and Oriental Insurance stopped the service from July 1 because of alleged over-billing by some high-end private hospitals.

Since then, regular meetings are taking place between hospitals, including Apollo, Max, Fortis, and insurance companies to resolve the crisis, but to no avail.

In response to a ‘DNA’ query, Sanjay Rai, director (marketing), Max Healthcare, said: “We are still in dialogue with insurance companies. They have agreed to allow emergency cases to be treated. We are working with them to come out with an appropriate solution.”

Max Healthcare has eight hospitals in and around Delhi. Rai said average 8-10 cases were being sent back every day due to the standoff.

Ranjana Smetacek, director (marketing and corporate communications), Fortis Healthcare Limited, said: “Fortis is working alongside other healthcare providers to communicate with insurance agencies and resolve this impasse. A dialogue has been started and a working committee formed to create a logical gradation and categorisation of hospitals, which will allow for corresponding and fair tariffs.”

“This situation impacts only retail policy holders of the four public sector insurance companies. The cashless facility for corporate policy holders continues as previously and private sector insurance companies form no part of this,” he said.

As per a recent study by third-party administrators (TPAs), of the over 3,000 hospitals across the country where insurance companies provide cashless services, 350 or roughly 11% were consuming more than 80% of claims. But both Rai and Smetacek denied allegations that hospitals were over-charging.
“Allegations about hospitals over-charging are groundless because TPAs control the approval process and prices are provided to all TPAs and insurance companies well in advance, prior to medical treatment,” Smetacek said.

TPAs are facilitators between the insured and the insurer.
The media coordinator for United India Insurance Limited said, “The matter has been resolved with most hospitals in Delhi. There are only 10 to 11 hospitals left and in another week or so it will be resolved with them also.”

Sudarshan Bharija, regional manager of New India Assurance in Delhi, said, “Picture is the same as before and there are no early signs of tie-up with the hospitals.”