The impasse over cashless treatment for health insurance policyholders has been resolved partially, with 10 big hospitals in Pune agreeing to provide the facility.
However, over 100 smaller hospitals have decided to permanently stop providing the cashless treatment facility.The Association , an umbrella organisation of 38 big hospitals in Pune and Pimpri Chinchwad, has decided to continue providing the cashless facility to individual as well as corporate policyholders of public sector insurance companies at 10 big hospitals. These hospitals have agreed to the revised 21% hike offered to them in the fixed treatment rate plan.
The remaining 28 hospitals covered by the association have also demanded a 21% hike in treatment rates, as against the 7% hike offered to them by third party administrators of public sector insurance companies. The association will continue to pursue this matter with insurance companies.
The hospital wing of Indian Medical Association (IMA), Pune, which has over 100 small- and medium-scale nursing homes as members, has also declined the offer for the 7% hike and has decided to permanently stop providing the cashless treatment facility at these nursing homes.
Manjusha Kulkarni, secretary of the association, said, “Ruby Hall Clinic, Jehangir Hospital, Poona Hospital, Sancheti Hospital, Deenanath Mangeshkar Hospital, Noble Hospital, KEM Hospital, Inlaks and Budhrani Hospital, N M Wadia Hospital and Aditya Birla Memorial Hospital have accepted the 21% hike offered to them in the fixed treatment rate plan floated by public sector insurance companies. Four hospitals have already signed the memorandum. The rest have agreed to the revision in principle and will sign the papers in a few days.”
Speaking about the remaining 28 member hospitals, Kulkarni said, “The 21% hike was offered only to 10 hospitals which, according to insurance companies, fall in the ‘A plus’ category of infrastructure norms. The rest were offered a 7% hike which is not acceptable to us. We have sought an appointment with insurance company authorities in this regard. We will meet them next week.”
Ranka Multispecialty Hospital, a 101-bed facility in Mukundnagar, is one of these 28 hospitals. Orthopaedic surgeon Ramesh Ranka, who heads the hospital, said, “We have been offered a 7% hike, which is not acceptable to us.”
Orthopaedic surgeon Nitin Bhagali of the hospital wing of IMA, Pune, said, “The third party administrators of public sector insurance companies have offered a 21% hike in the fixed rate plan for 62 common disorders to 10 big hospitals in Pune and Pimpri Chinchwad. The remaining multispecialty and single specialty hospitals have been offered a 7% hike. We have declined this extremely poor and unacceptable offer. We have decided to permanently stop providing the cashless facility to policyholders of public sector insurance companies henceforth.”
Bhagali added, “We are opposed to the idea of classifying hospitals on the basis of infrastructure. Instead, expertise, seniority and profile of doctors should be given more weightage in deciding the rate list for various procedures.” The association is also opposed to the current practice of offering different rates to different hospitals for the same procedures, he said.Patients will still be able to undergo treatment in a hospital outside the preferred provider network (PPN), but they will have to pay the bills first and then file a claim with the insurer, who will settle it after scrutiny, Bhagli said.
Influence: It has about 38 large hospitals in the city under its ambit.Decision: To continue cashless facility at 10 big hospitals who have agreed to the revised 21% hike in treatment rates. The association will pursue matter of rate revision with insurance companies for its remaining 28 members who are offered seven percent hike in treatment rates
The hospital wing of IMA, Pune
Influence: Over 100 small- and medium-scale nursing homes are members.Decision: To stop cashless facility permanently till insurance companies revise treatment rates
Insurer vs Hospital
* Insurers have standardised rates for 62 medical procedures across categories of hospitals to settle cashless claims. They say they are running into losses due to inflated medical claims from hospitals
* Hospital managements say the rates are ridiculously low. They argue that policyholders pay huge premiums to get the best treatment and insurers’ rates don’t match the expectations of patients
Note for patients/relatives: Before admission, confirm with the hospital management/ third party administrator (TPA) if the cashless benefit is available
Curated from: 10 hospitals to offer cashless facility