Times of India
31 July 2010
By Manthan K Mehta
Mumbai, India

In a major relief to health insurance policy holders, public sector insurance companies have announced that cashless treatment will be extended to all hospitals in emergency and trauma cases.

At a healthcare meet with the Confederation of Indian Industries (CII) held in New Delhi on Friday, New India Assurance Company chairman M Ramadoss said a patient who requires emergency and trauma services will be attended to, through the cashless scheme, in all third party administrator–empanelled hospitals.

"To avoid any inconvenience to the public, TPAs have been instructed to provide this facility to those hospitals which are not part of the preferred provider network (PPN) of hospitals, which are recognised by insurance companies,’’ said a PSU official.

Health insurance policy holders were left in the lurch after public sector insurance companies decided to restrict cashless mediclaim policies to only those hospitals that feature in the PPN. Some hospitals were blacklisted for following fraudulent practices while several others opted out of PPN after they refused to adhere to the rate card prescribed by insurance firms for surgeries and treatments. The PPN now comprises 81 hospitals in Mumbai, 145 in Delhi NCR, 75 in Chennai and 70 in Bangalore.

An official said that emergency and trauma cases will have to be certified by third party administrators (TPAs) to avail of cashless benefits. A total of 24 TPAs are linked with the General Insurance Public Association, a body that comprises the four public sector general insurance companies– New India Assurance Company, National Insurance Company, Oriental Insurance Company and United India Insurance Company.

The official said planned or elective surgeries such as bypass, knee replacement and cataract, among others, do not fall under the category of emergency or trauma cases.

Cases such as accidents or treatments that require immediate admission to the intensive care unit (ICU), though, will termed as emergency or trauma cases. The official said, "Assuming that a person suffers a sudden heart complication or a stroke and has to be immediately shifted to an ICCU for treatment or surgery... in such cases, we will have to extend the benefits of the cashless scheme.’’

Meanwhile, at the CII meet, senior officials of the insurance companies as well as key corporate healthcare providers decided to establish a process to resolve the sticky situations that arise out of the cashless imbroglio.

In a statement released on Friday, the CII said, "Over the next 30 days, the group consisting of insurers, third–party administrators and (healthcare) providers will meet frequently to establish a methodology whereby a common understanding on packages for a select number of procedures will be arrived at.’’

Easing The Trauma

• New India Assurance chairman M Ramadoss said a patient who requires emergency and trauma services will be attended to, through the cashless scheme in TPA–empanelled hospitals
• Planned or elective surgeries such as bypass, knee replacement and cataract, do not fall under the category of emergency or trauma cases