PSU insurers agree to restore cashless treatment facility

"The insurance companies have decided to restore cashless facilities on a case-to-case basis. We discussed ways of making people part of the facility and how the reimbursements to them can be revived," head of health insurance vertical at ICICI Lombard Sanjay Datta told PTI after a CII-initiated meeting between insurers and the healthcare industry.

The state-owned insurance companies, Oriental Insurance, New India Assurance, National Insurance and United Insurance, have also agreed to expand the network of hospitals providing cashless treatment facility (Preferred Provider Network) for the benefit of mediclaim policy holders.

"The insurance companies reiterated their current position of willingness to expand the PPN (Preferred Provider Network) and in 90 days work with CII and other stakeholders to address areas of concern," CII said in a statement.

Industry body CII called a joint meeting of the insurers and the healthcare industry to resolve the impasse following withdrawal of cashless treatment facility at about 150 hospitals by four PSU insurance companies from July 1 on allegations of over-billing.
Speaking at the meeting New India Assurance CMD M Ramadoss said hospitals and customers need to "respect and maintain" integrity.

"In order to keep health insurance premiums affordable and viable all stakeholders including the consumers have to respect and maintain the integrity of the system," he said.

As regards the patients seeking treatment under mediclaim scheme, Fortis Hospitals CEO Vishal Bali said they would have to seek reimbursement for claims for treatment in delisted hospitals.

The insurers and the healthcare industry also agreed for gradation of hospitals for the purpose of mediclaim facilities. The hospitals would be graded in three categories -- A,B and C-- on the basis of infrastructure facilities and specialties.

The grading, according to S Gopalakrishnan, New India Assurance General Manager, will not have any impact on the premium being paid by policy holders but would help the insurance companies in cutting down losses."Following gradation, there will only be a change in contract between the insurers and the hospitals", said Datta.Besides the insurance companies, the meeting was attended by representatives of Fortis, Max Healthcare, Apollo Hospitals