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Times of India
21 August 2010
By Manthan K Mehta
Mumbai, India

It Will Deal With Insurers’ Treatment Rate Card
Following the controvery over cashless insurance facility, a core committee comprising healthcare associations has been formed to work out a common strategy to deal with the standardised rate card prepared by insurers for various treatments.

From now on, only the committee will hold discussions with General Insurance Public Sector Association (Gipsa) on the cashless scheme. In other words, no asssociation will deal with Gipsa individually. Gipsa is a group of four public sector general insurance companies. Anoop Verma, head of marketing, Jaslok Hospital, and coordinator of the core committee, said: "Henceforth, all negotiations with Gipsa on the cashless issue will be conducted by this core committee.’’ Major general Vijay Krishna, CEO, Breach Candy Hospital, has been appointed as the committee’s chairperson.

Meanwhile, several hospitals say they have decided to opt out of Gipsa’s list of preferred provider network (PPN), although their names feature in it. Hospitals under the PPN have to adhere to the rate card that has been prepared by insurance companies.

On Friday, representatives of the Association of Hospitals, Bombay Ophthalmologists Association, Bombay Nursing Home Association and the Association of Medical Consultants met at Jaslok Hospital to discuss their future course of action.

While Gipsa claims that 132 hospitals have enrolled in the PPN, Association of Medical Consultants (AMC) says that more than 70 hospitals have already withdrawn from it. Dr Sujata Rao, president (interim), AMC said, "Insurance companies are misleading the medical fraternity about the number of PPN enrollments. Many of the hospitals have decided to opt out of the PPN. Not just eye hospitals, even nursing homes have decided to stop the cashless facility after our association boycotted the directives issued by insurance companies.’’

Dr Nitin Malkan of Malad West said, "I had signed a memorandum of understanding (MoU) to join the PPN. However, four days ago, I withdrew my name to show solidarity with my association.’’

Moreover, he alleged that third–party administrators (TPAs) are not adhering to the rate card. "I had carried out a surgery and submitted a bill of Rs 21,000. However, the TPA was willing to reimburse only Rs 18,000,’’ said Dr Malkan.

Dr Manoj Gandhi, president, Bombay Nursing Home Association, said, "The name of one our members features in the PPN even though he has not signed the MoU.’’

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