Only claims from hospitals agreeing to insurance firms’ slabs will be entertained.
Even if you have a cashless health insurance policy, ensure that you have enough cash on hand to pay for treatment during emergencies.
Several top corporate hospitals have been turning down cashless policies and insurance companies are still negotiating with them. Until some consensus is reached, the cashless insurance holder is expected to pay for the medical expenses and claim refund from the insurance company — a process that could take months.
To resolve the issue, insurance company leaders and top corporate hospitals met on Tuesday in Mumbai to seek long-term solutions. “The insurance companies have agreed to broaden their preferred provider network and include more corporate hospitals. They have agreed to categorise hospitals based on technical competence and infrastructure, and charge different premiums based on these categories. Also, insurance companies will have different pricing structures for different hospitals,” said Vishal Bali, CEO, Fortis Hospital, who attended the meeting.
Reimbursement would also be procedure-based. This means, if a patient with an insurance cover of say Rs5 lakh runs up a bill of Rs3 lakh on medical treatment, he or she may to have to still pay up if the insurance company feels the procedure is worth only Rs2 lakh.
At present, the four-major state-run insurance companies run by General Insurance Public Sector Association — United India, New India, Oriental Insurance and National Insurance — have decided to stop cashless transactions at select hospitals. “The association has introduced four packages. Corporate hospitals that agree to their rates would be included in the preferred provider network to entertain cashless policies,” said Dr Niranjan Rai, corporate relations, Manipal Hospital.
He said hospital authorities would soon negotiate with insurance companies about charges for various procedures.
However, the official communication to scrap cashless policies has not been sent to all hospitals. “Until we get an official communication, we will continue to accept cashless policies.
However, insurance companies are negotiating with hospitals on charges,” said Ravindra Pai, vice-president, Apollo Hospital.
This would, however, apply only to individuals who personally opted for the insurance, and not for corporates that offer group insurance to employees and their families.
Whatever be the case, it will hit the middle-class hard. “I underwent a medical procedure six months ago and am still waiting for the reimbursement. This is precisely why people prefer cashless insurances,” said a 62-year-old banker, Ashish Agarwal.
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