The small and medium hospitals in Pune have raised several concerns over the new and renewal of empanelment by insurance companies. The constant haggling between hospitals and insurance companies has drastically reduced the number of hospitals offering cashless facilities, leaving several patients without cashless treatment. There are four public and several private insurance companies offering mediclaim facilities with multiple packages. In addition, these companies have appointed about 150 third party administrators. However, the number of small and medium hospitals offering the cashless scheme has come down from 350 to 80 in Pune city, doctors said.
Dr Sanjay Patil, chairman of the Hospital Board of India, Pune chapter, said the insurance companies have limited the number of empanelment slots with a few hospitals in an area for ease of business, resulting in trafficking of patients.
“They are trafficking patients and this practice should be stopped at the earliest. Patients have the right to choose the hospital, which is not possible as few hospitals offer cashless facilities. In many cases, the companies offer lesser amounts than what was approved during the settlement of the claim. In case of reimbursement, there is a delay from the companies and the hospital suffers as it loses the working capital,” he said.
The Hospital Board of India (HBI), Pune Chapter, and the Indian Medical Association (IMA), Pune Chapter, have written to the insurance companies several times, but to no avail. In India, patients seek treatment from doctors and not from hospitals. This also forces patients to seek treatment only in corporate hospitals and end up paying huge amounts out of pocket and their insurance cover gets exhausted soon, they claim.
Highlighting the same issues faced by several other hospitals across the country, the HBI, a national body on December 5 wrote to the General Insurance Council stating that the Third Party Administrators and ICS are pressurising the hospitals to accept non-viable packages they give and renew their empanelment’s failing which they will be dis empanelment which is not a healthy trend being followed by them.
The HBI, India has requested the GIC to discuss issues like empanelment of all registered hospitals, work out and come out with a common scientific template from which packages can be derived before empanelment. Also, representation of associations in policy making bodies of GIC, IRDAI, common redressal forum where problems faced by each stakeholder could be raised and resolved.
Dr Ravindra Chajjed, Director of Harsh Hospital, said that despite several requests, the hospitals were not getting empanelment or renewal. Even during the agreement, the rates quoted are not at par with the costs and the companies are asking for discounts on the packages.
“The insurance companies also say that co-payment is not allowed, so hospitals are reluctant to start the cashless facility,” he said.
