Row over cashless health services to be resolved

“We hope the hospitals and the insurance companies will soon sort out problems over the issue of withdrawal of cashless facility,” IRDA Chairman J Harinarayan told newspersons, on the sidelines of a health insurance conference organised by the FICCI here.

When asked why IRDA is not intervening in the matter he said, “We view this more as a commercial transaction problem between the insurance companies and the hospitals and not really as a regulatory issue.” However, Harinarayan asserted the IRDA would come into picture if there was a breach of contract between the insurance company and the insured person.

Public sector insurance companies had from July 1 taken off nearly 150 hospitals in Delhi, Mumbai, Bangalore and Chennai from the list of Preferred Provider Network (PPN) of health institutions offering cashless hospitalisation services to policy holders under the mediclaim scheme.

The four insurance companies—New India Assurance, United India Insurance, National Insurance and Oriental Insurance—had stopped the cashless service because of alleged over-billing by some private hospitals, which impacted their insurance business.

Shortly after this, top representatives of the fPSU insurance firms and some key healthcare providers had decided to resolve the issues arising from the withdrawal in a time-bound manner. At a CII-sponsored meet, both the sides decided to form a working group comprising representatives from insurance firms and leading private hospitals and Third Party Administrators  to find solutions.

“Over the next 30 days, the group will meet frequently to establish a methodology whereby a common understanding on packages for a select number of procedures will be arrived at,” Naresh Trehan, Chairman CII National committee on Healthcare said.

The cashless facility would be extended to a patient requiring emergency, cardiac and trauma services in all the TPA-empanelled hospitals, Chairman of New India Assurance Company, Ramadoss, had said.