Cashless mediclaim facility to be restored today

Corporate hospitals, insurance companies agree over pricing

Insurance companies and corporate hospitals have agreed on a three-tier pricing package for treatment of various kinds of common ailments after several rounds of negotiations.

The basic modalities of the package, which will determine the cost of treatment for 42 varieties of ailments to be charged by corporate hospitals, were arrived at between some of the leading high-end private hospitals and Third Party Administrators (TPAs), who are the facilitators between the insured and insurance companies for the settlement of claims.

Some of the major corporate hospitals such as Apollo Healthcare, Max, Medicity, Medanta and Fortis are understood to have given their package rates to the TPAs. “The TPAs will now get back to the hospitals on the package rates. Cashless facility in corporate hospitals would be restored on an interim basis by tomorrow (Friday),” Max Healthcare Institute Managing Director Pervez Ahmed, who headed the CII National Health Committee, said.

The committee had appointed a six-member panel comprising representatives of corporate hospitals and TPAs to resolve the impasse over cashless treatment by working out a compromise on rates and a common slab for different ailments.

Final settlement distant

However, it will take some time for hospitals and insurance companies to arrive at final settlement on the issue (of rate structure), Ahmed said.

“The detailed rate structure would be decided in the next one month. Under the structure that is being worked out, hospitals would be categorised on the basis of superspecialty  as well as overall infrastructure facilities. Thus premiums would vary accordingly,” he said.

Explaining the modalities for fixing the cost of treatment for various kinds of illnesses, Ahmed said the package rates would be segmented on the basis of the category of hospitals.

As per the settlement between corporate hospitals and the TPA there will be three categories––A, B, C––for classification of hospitals. The cost of treatment for the same kind of illness will differ from hospital to hospital depending on the categorisation. This would eventually lead to insured paying out higher premiums for treatment in super specialty medical centers.

The four PSU insurance companies –– New India Assurance, United India Insurance, National Insurance and Oriental Insurance––have been pressing for rationalisation of rates for cashless facility as they claim to have suffered a loss of Rs 2,000 crore because of overcharging by hospitals in  Mumbai, Delhi, Chennai and Bangalore.