New Delhi: Private hospitals will resolve
their dispute with state-owned insurance firms and restore
cashless treatment under Mediclaim policies within 10 days,
Naresh Trehan, heart surgeon and member of a conciliatory
group, said today.
"Within the next 10 working days, insurance companies
and hospitals would work out a solution," he said, adding that
the cashless facility would be restored soon.
Trehan, who has promoted Medanta - The Medicity, was
speaking to reporters after a CII-initiated meeting of private
hospitals with representatives of four insurance companies --
New India Assurance, United India Insurance, National
Insurance and Oriental Insurance.
All the 150 hospitals have partially restored the
cashless facility for emergency, ICU, cardiac care and trauma,
Earlier in the day, insurance regulator IRDA chairman J
Harinarayan had expressed the hope that hospitals and insurers
would be able to arrive at a mutual solution.
"Premier hospitals and insurance can come (up) with the
solution ..." he said on the sidelines of a Ficci event here.
The action group comprised four public sector general
insurance companies and private hospitals. The members of the
group included Apollo Hospitals Group Chairman Prathap C
Reddy, Fortis Healthcare Managing Director Shivinder Mohan
Singh, Max Healthcare Institute Ltd Managing Director Pervez
Ahmed and Medanta - The Medicity Chairman Naresh Trehan.
While the group is headed by Pervez Ahmed, CEO and
managing director of Max Healthcare Institute Ltd, on the
insurance side, it is headed by Pawan Bhalla, CEO of Raksha
TPA, the third party administrator (TPA) that is the
facilitator between the insured and the insurer.
It is to be noted that from July 1, public sector
insurance companies had taken off about 150 hospitals from
its list of Preferred Provider Network (PPN), which provides
cashless hospitalisation services to policy holders under the
Acknowledging that there had been some instances of
over-billing, Trehan said insurance companies have legitimate
concerns that there is some disproportion between premium
collected by insurance companies and the payment made.
"So, there is a need to bring alignment ... balance
between best price and quality healthcare," he said.
At present, health insurance is a loss-making proposition
for many insurance firms as the claim ratio is about 130 per
cent. This means that for a premium of Rs 100 collected, the
claim received by insurance firm is Rs 130. There are about
eight crore Mediclaim policy holders in the country.
Trehan said the meeting held that the rules of engagement
should be defined so that people do not lose money.
On whether there would be standardisation of the billing
process in different hospitals under cashless treatment,
Trehan said, "The meeting today did not discuss this, but in
the future we may take a view on it."