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Times of India
19 August 2010
By Pradeep Thakur
New Delhi, India

Big Hospitals, Insurers Set To Agree On 3-tier Rates For 42 Procedures
The cashless hospitalization facility may soon be restored at most of the major corporate hospitals in Mumbai, Delhi, Bangalore and Chennai with the impasse between insurers and big hospital chains on the verge of a resolution.

After intense negotiations spread over several days between the two sides, a three–tier package has been worked out for 42 standard medical procedures that cover almost all common ailments requiring hospitalization.

As per the compromise formula, hospitals have been divided into three groups based on infrastructure capabilities. While in Delhi negotiations with high–end hospitals have already begun, in Mumbai, the category will include Breach Candy, Hiranandani, Jaslok, Lilavati and Hinduja. Manipal in Bangalore and Apollo and Fortis in Chennai may also make the top grade. The complete list will be available once these hospitals sign the deals with TPAs.

In Mumbai, however, some of the high–end hospitals are still agitating on the question of a package deal. ‘Mumbai, Delhi can’t have same insurance rates’ Dr Sujit Chatterjee of Hirandani Hospital said it was not possible for them to sign on the rates that could be applicable in Delhi. He cited difference of realty prices in both the cities as one of the reasons to justify the case for higher rates in Mumbai. He said at least 50 charitable hospitals like Hirandani have refused to service CGHS clients as the rates are simply not acceptable for them being so low.

Big Hospitals, Insurers Set To Agree On 3-tier Rates For 42 Procedures
While 450 hospitals across these cities had already joined the cashless network, the absence of the corporate hospitals constituted a vital missing link in the medical insurance chain. The corporate hospitals had been taken off the preferred network after July 1 when they refused to standardize their treatment procedures, and agree to a package deal with insurers.

The package rates have been worked out by a committee headed by Raksha TPA CEO Pawan Bhalla who facilitates the northern region business of health insurers. Earlier, all the four major public sector insurers in consultation with high–end hospitals had empowered a committee comprising Dr Pervez Ahmed, CMD of Max Healthcare, and Bhalla to work out a compromise on rates and a common slab for different ailments. "The rates have been segmented into three categories because highend hospitals cannot be pushed to accept tariffs applicable for smaller ones,’’ said Bhalla. Once these are signed by major chains in north, the package deals will be extended to other regions.

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