Times of India
30 March 2011
By Jyoti.Shelar

City doctors have decided to not let their dispute with public sector insurance companies affect their patients. They are considering reintroduction of Cashless Medical Insurance scheme for those who hold health policies from private insurance providers.

The scheme is a health insurance policy which allows patients to get treatment without having to pay for it at the hospital. The insurance company settles the bill directly. The aim is that a person should not have to worry about arranging funds when faced with a medical emergency that needs hospitalisation.

But to check the increasing ratio of cashless Mediclaims and inflated bills from hospitals, four public sector companies – New India Assurance, Oriental Insurance, United India Insurance and National Insurance – introduced preferred provider network (PPN) programme in July last year.

The programme gave a fixed tariff rate card for more than 40 different surgeries and accepted cashless treatment claims from only PPN–accredited hospitals.

The PPN was started because the insurance companies felt that the hospitals were inflating their bills to avail high reimbursements under the cashless mediclaim facility. Healthcare providers were taken aback with the sudden introduction of the PPN and were upset that the rates were extremely low. For smaller hospitals and nursing homes the rates were slashed up to 30 per cent of what they charged earlier, and for bigger hospitals the rates were reduced to less than 50 per cent.

"The insurance companies tried to dictate terms which forced us to completely stop giving cashless claims. But the patients were suffering because of all this," said Dr Saurabh Dani, member of the Association of Medical Consultants (AMC). "We are planning re–introduction of the cashless scheme for private policy holders at least. It will be a win–win situation for the hospital, insurance company as well as the patients," Dani added.

Agreed Sanjay Datta, customer head of ICICI Lombard, "Some hospitals have already started offering cashless facilities for private policy holders. We are in talks with the rest of them to ensure that patients don’t have to suffer."

However, starting cashless scheme for private policy holders alone doesn’t solve the problem. Only 15 per cent of the medical insurance holders avail service from the 16–odd private health insurance companies – the rest are with the government insurance providers following the PPN model.

"We have had several meetings with the public and private sector insurance companies. We are trying to work out a way that suits everyone," said Vijay Krishna, president of Association of Hospitals (AoH).