New Delhi: A decision on resuming cashless
mediclaims in all city hospitals will have to wait till next
week, as a meeting today of insurance administrators failed to
finalise the rate structure.
"Third Party Administrators (TPAs) are yet to finalise on
the rate structure. We expect them to revert next week," Max
Healthcare Institute MD Pervez Ahmed, mediator for the private
Earlier, it was reported that patients would be able to
take advantage of cashless treatment facility from today.
TPAs, or the facilitators between the insured and
insurers, were expected to revert to hospitals today with the
benchmark rates for hospitals, but they are yet to finalise
the tariff structure.
"We are hopeful of finalising the rates by next week.
Still some work needs to be done," said a TPA source, who is
negotiating on behalf of the insurers.
The cashless medical facility was suspended by four PSU
insurers -- New India Assurance, United India Insurance,
National Insurance and Oriental Insurance-- from July 1 after
they alleged over-billing by certain private hospitals.
The restoration of services is taking longer than
expected because at a recent meeting hospitals are believed to
have quoted rates quite higher than the tariffs under the
current arrangement, called preferred provider network (PPN).
At the meeting, attended by the representatives of
private hospitals and TPAs, the two parties had agreed to
categorise the hospitals on the basis of infrastructure
availability and benchmark rates accordingly.
As such, those opting for treatment in super-speciality
hospitals like Apollo, Escorts are likely to shell out more
money for new premiums than those going for ordinary health
For super-speciality hospitals--Max, Fortis, Apollo and
Medicity--the rates at Ganga Ram Hospital will be used as
benchmark for the new rate structure.
The facility at another set of hospital like Rockland, St
Stephens, Holy Family, Batra and Sitaram Bhartiya, however,
would be based on lower premiums.
The hospitals and TPAs have worked out package rates for
42 procedures, and they are now working out the rate
structure, industry Chamber CII, which is mediating for a
solution to the vexed issue said in a statement.
While corporate hospitals like Ganga Ram, Max and
Medicity have given their package rates to the TPAs, Apollo
and Fortis are yet to submit their rates.
Meanwhile, in a reply to the Lok Sabha, Minister of State
for Finance Namo Narain Meena said that the PSU insurers are
paying 40 per cent more than the premiums collected in claims.
"The public sector general insurers have been incurring
claims in excess of premium received and after factoring in
acquisition costs, which are around 10 per cent, and the
management expenses which are over 25 per cent, the Combined
Ratio i.e. the total expenses for health portfolio exceed 140
per cent of the premium income," Meena informed Parliament.
Public sector insurance companies had to resort to
rationalisation of rates for cashless facilities as they
suffered a loss of Rs 2,000 crore because of overcharging by
hospitals in Mumbai, Delhi, Chennai and Bangalore.