Policy holders fret over insurance industry move

Many worry that stoppage of cashless facility will hit patients
Last Updated 14 July 2010, 19:55 IST

While hospitals claim that quality treatment comes at a high price, many people feel that corporate hospitals do tend to overcharge when they know the person is insured.

Manjunath, a young software engineer is undergoing treatment for bone cancer. His treatment has already run into lakhs of rupees and he has been able to afford it only with the help of the cashless insurance policy. “Without the scheme, it would have been difficult for us to cope with the exorbitant bills,” says his retired father, Siddappa Bannur.

Anusuya, another cancer patient, feels that patients will not have a lot of money on hand, especially if they are undergoing expensive treatment. “Getting health loan at a short notice is impossible. So cashless facility is the only way to avail quick treatment,” said Anusuya’s husband Ranganatham.

However, there were also some people who felt that cashless insurance meant hospitals charging for unnecessary treatment. Lorna Pothan recalled how a corporate hospital asked her to get admitted for typhoid, which was manageable at home.

"I had gone to the hospital expecting the doctor to prescribe medicines to me. However, the doctor kept me in the hospital for five days," Lorna said. At the end of it, she got a bill of Rs 45,000, which she felt was high because of the insurance. 

Hospitals’ view

After an internal meeting, Private Hospitals and Nursing Homes Association Bangalore (PHANA) on Wednesday felt that withdrawal of the cashless scheme would affect patients, especially from the middle and lower middle classes. The move would deprive patients the right to select the hospital to avail the treatment.

Hence, PHANA has decided to facilitate joint meetings between hospitals, nursing homes, insurers and the Third Party Administrators (TPA).

Meanwhile, Vishal Bali, COO, Fortis Hospital, who had attended the high level meeting in Mumbai between insurance companies and private hospitals, said insurance companies need to define products and procedures and limitation on them.

He revealed that in the coming 90 days, insurance companies, hospitals and TPAs will hold more meetings to refine the process and expand the TPA coverage. 

Dinesh Madhavan, Marketing Director, HCG, Bangalore said: “ We have not stopped accepting cashless insurance scheme. Nobody abroad pays with money, when the world is moving into using cards in place of cash, we are indeed going back to the old reimbursement system."

According to Manipal Hospital medical director Dr H Sudarshan Ballal, the insurance companies have done enough homework before implementing the cashless scheme. He felt that framework was needed to prevent frauds by having pre-authorisation of surgery except in emergency situation and reworking on the treatment cost in City-based hospitals.

(Published 14 July 2010, 19:55 IST)

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