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

Some city hospitals have started negotiations with insurance firms to arrive at a settlement over the rate card for various medical procedures. The move may help end the deadlock between insurance companies and hospitals over the issue of cashless facility.

Thousands of patients across the country were left in the lurch after four major public–sector insurance firms decided to drastically pare down the number of hospitals from their preferred provider network (PPN).

Officials of several city hospitals met on Wednesday to thrash out several issues, including the “vilification campaign” carried out by insurance majors about hospitals overcharging insured patients, a source said, adding that the meeting will continue till Friday.

“Several hospitals, including Jaslok, have had several rounds of meetings with insurance firms to find a solution. More hospitals are likely to follow suit,” the source added.

Anoop Verma, head of marketing, Jaslok Hospital, said, “We have not been struck off the PPN. However, we are not satisfied with the decision of the insurance firms. We have opted to initiate negotiations and are hopeful of arriving at a mutual understanding that takes care of the interests of all parties, including the patients.”

Col Maneesh Masand, CEO of Jaslok Hospital, said, “The rate card prepared by the firms is not fair. The cost for some medical procedures is higher than what we charge, while in some cases, the charges are far below our expectations.”

Giving examples of the irrational pricing, Verma said, “The insurance firm offers a rate of Rs 38,000 for an angiography (twin sharing basis), which is higher than the rate we charge. For a bypass surgery, however, the firms are willing to offer Rs 1.80 lakh, irrespective of whether or not the operation is done by beating heart surgery.”

Jaslok and the insurance firms are likely to arrive at a mutually acceptable rate for 6–10 of the total 43 procedures listed. Verma said, “We have decided to undertake a pilot project where treatment will be carried out at mutually agreeable rates for a year. At the end of the year, we will come to know whether the rates are affordable.”

“The pilot project will be undertaken on the condition that the insurance companies settle the bills within 10–15 days from the day the claims are submitted. Moreover, the insurance firms are not to put a cap on other aspects of treatment like room rate, ambulatory services etc,” Verma said.

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