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Indian Express
05 August 2010
Mumbai, India

The association of private hospitals have sought state government’s intervention to settle the ongoing dispute with insurance companies over cashless mediclaim policy.

The association, which includes hospitals like Jalok, Breach Candy, Hinduja and Hurkisondas, has said that the demands of uniform rates for medical procedures that had been put forth by insurance firms were not plausible. “Rates differ according to available equipment and location of hospitals. Even within hospitals, rates vary according to the class of service patients opt for,” said CEO of Jaslok Hospital Colonel Manesh Masand. He added that costs also vary for different procedures for the same ailment. “Cancer can be treated by focused MRI and through surgery, at exponentially different costs. The choice of treatment is finally up to the patient,” said Colonel Masand.

“Government intervention is required here. Petrol is being made duty free, whereas hospitals have to pay the highest custom duties for all imported equipment. It is important to understand that our costs are determined by all these factors,” said Breach Candy Hospital CEO Major General Vijay Krishna.

The hospital authorities also rubbished allegations of overcharging. “The billing system in private hospitals is fixed and freely available for all patients to see in advance. Where is the room for exceeding the set charges for particular procedures?” said Pramod Lele, CEO of Hinduja Hospital.

The hospital authorities said that if the government approved some nodal agency for rating hospitals, they were willing to subscribe to rates as per these gradations. They added that they were open to dialogue with insurance companies to resolve the deadlock. “Our beds are full. Striking off cashless treatment has not really affected our inflow. But in this conundrum, patients are suffering, as we are forced to turn away many who produce cashless mediclaim cards,” said Lele. He added that hospitals were willing to negotiate rates, provided insurance firms take the comprehensive cost of healthcare into account.

Public sector insurance companies had alleged that hospitals were billing patients higher and extending their stay in hospitals if they were insured under the cashless treatment policy. Cashless mediclaim was restricted to hospitals figuring in the Preferred Provider Network– a list drawn up by insurance companies from July 1.

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