Private hospitals in Bengaluru threaten to stop cashless insurance

BENGALURU:

Private hospitals

in Bengaluru are threatening to stop honouring cashless claims of public

sector insurance

companies from June 1 unless these firms stop dictating tariffs for treatment.


The decision to discontinue the cashless claims was taken on Wednesday at a meeting of the Private Hospitals and Nursing Homes Association (Phana), Bengaluru. Phana has over 400 hospitals in the city as members.

Over 60% of patients visiting a corporate hospital avail

cashless insurance

schemes. If the cashless facility is stopped, patients will have to pay the hospital upfront and then apply for reimbursement from the insurance company. Phana members at the meeting deliberated on the problems faced by private hospitals
because of the reluctance of insurance companies to hike treatment costs.

Though the association had sent a communication to the insurance companies that it would not honour cashless claims from May, the meeting on Wednesday decided to extend the deadline by a month. “It will be too short a notice for patients if we say May, and hence we have extended it by a month,” said Dr Nagendra Swamy, principal coordinator, Federation of Healthcare Associations - Karnataka.

He said GIPSA (General Insurance Public Sector Association) has come up with its own tariff rate which the hospitals cannot accept. “These companies are profit-based and they think we should accept their tariff. That is impossible,” said Dr Swamy.

The insurance sector’s argument is that the private health industry in Karnataka artificially raises rates for standard treatment procedures and surgeries. PSUs like New India Insurance, United India Insurance, Oriental and National Insurance have been partially or outrightly rejecting claims from private hospitals saying these are bloated.

"They can't fudge numbers with insurers, so they've decided to target patients. Patients will suffer because now they have to pay money upfront and then claim for reimbursements from us," said a PSU official. Hospitals have been pushing hard for a revision of rates, but insurers are calling the rates "unrealistic and extortionist."