Provide proof of pending insurance dues, hospitals told
The Private Hospitals and Nursing Homes Association (PHANA) has directed all hospitals and nursing homes to produce documents supporting their claims of health insurance overdues to be paid by third party administrators (TPAs).
During an executive committee meeting on Tuesday, the Association decided to send letters to around 100 hospitals, asking them to produce proof regarding pending dues.
The meeting was a prelude to another meeting scheduled by PHANA with chief general managers of the four public sector insurance companies –– National Insurance, New India Assurance, United India Insurance and Oriental Insurance –– along with TPA representative Medi-assist, this week.
“The TPAs have to immediately clear all our outstanding bills pending since 2002. Almost 90 per cent of the nursing homes and hospitals have not received any payments. We want this matter cleared, else we will have to approach the judiciary,” said PHANA Joint Secretary Dr Aravind Gubbi.
PHANA also opposed the decision of insurance companies to stop cashless facility, saying poor patients would suffer, especially during emergencies.
Besides, a uniform rate list for common surgical procedures should be fixed depending on the quality and bed strength.
However, some insurance companies were using arm-twisting tactics to make nursing homes and hospitals agree to their terms.
“Insurance companies have been individually approaching nursing homes and hospitals asking them to sign the agreement by July 31. They have been threatened that if they refuse, their hospital would be de-recognised,” PHANA president Dr H Paramesh said.
He added that he learnt about this from at least three hospitals on Tuesday. He also said that insurance companies had not provided PHANA with the names of the nursing homes and hospitals, which were charging exorbitant rates.
Vishal Bali, CEO, Fortis Hospitals, who was part of the delegation that held national-level negotiations with insurance companies earlier this month in Mumbai, agreed that many hospitals, including Fortis, had huge overdues yet to be paid by the TPAs.
He added that the health industry was drafting the structure of banding of hospitals and pricing points based on the service and quality of treatment. And this would be proposed to insurance companies.
DH News Service
