New Delhi: The private sector hospitals and
PSU insurers are likely to arrive at an interim settlement on
restoration of cashless treatment facility at major hospitals
in the country from tomorrow.
The major corporate hospitals -- Apollo Healthcare, Max,
Medicity and Fortis-- have given their package rates for
treatment under mediclaim policies to the Third Party
Administrators (TPAs), which are the facilitators between the
insured and the insurer.
"By tomorrow, TPAs will revert to the hospitals on the
package rates. Cashless facility in these hospitals would be
restored on an interim basis by Friday," Max Healthcare
Institute MD Pervez Ahmed told PTI.
Although the cashless treatment facility will be restored
from tomorrow on interim basis, it would take some time for
the hospitals and four PSU insurance companies to arrive at
final settlement on the vexed issue.
"Final rate structure would be decided in another 30-40
days. Under the structure that is being worked out, hospitals
would be categorised on the basis of super specialty medical
centres and premiums would vary accordingly," he said.
Currently there are 449 hospitals across the country
under the cashless network, but corporate hospitals were
removed by the PSU insurers from their preferred provider
network (PPN) from July 1.
Four insurance companies -- New India Assurance, United
India Insurance, National Insurance and Oriental Insurance --
had stopped the cashless service to these hospitals on charges
of over-billing.
Ahmed said the package rates have been segmented on the
basis of categorised hospitals. "There will be three
categories -- A, B, C-- for classification of hospitals and
each segment could also have a sub-category," he said.
The categorisation would happen on the basis on
infrastructure facilities available in these hospitals.
Industry players said such agreement would eventually
lead to insured paying out higher premiums for treatment in
super specialty medical centres.
Such differential pricing would help the health insurance
industry, which is currently a loss-making proposition.
Currently many health insurer give more in claims than
they collect from premiums. In fact, the claim ratio, which
measures this trend, is about 140 per cent for the industry.
There are about eight crore mediclaim policy holders in
the country.
The 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.
PTI
