Delhi hospitals put off cashless service facility till next week

NEW DELHI: Dr Pervez Ahmed, chairman and managing director of Max group of hospitals, told TOI on Friday that the corporate hospitals in the Capital have deferred cashless service, which was to start from Friday, till next week as an interim measure while the final rate structure for all 42 medical procedures that covers almost all ailments requiring hospitalisation could take another 20-30 days.
He explained that what Raksha TPA (Third Party Administrator) has divulged about the rates on some common procedures were part of "internal discussions" and required final approval. "We have given them (TPAs) rates and they are yet to come back to us," Dr Ahmed said.
Dr Ahmed is head of a committee, with Raksha TPA CEO Pawan Bhalla as representative of the four major public sector insurers, which was appointed by PSUs and corporate hospitals to work out packaged rates for standard medical procedures. In their August 12 meeting, the packaged rates for 42 procedures were worked out.
M Ramadoss, CMD of New India Assurance, a leading PSU health insurer, told TOI that all PSU insurers have authorised Raksha TPA to negotiate rates with corporate hospitals and it is in the process of finalising it.
Were the rates, published in TOI as disclosed by Raksha, varied in a big way than what is being demanded by corporate hospitals? "No, they don't have variations. In some cases, they are higher than what we had been billing," said Dr Pervez Ahmed, adding that only TPAs need to get them verified from each hospitals before implementation.
"That was internal report and not to be discussed. The procedures we had discussed were basic and much more required to be added," he said.
TOI, in edition dated August 19, quoted Pawan Bhalla as saying, rates have been finalised by Raksha TPA and have been conveyed to hospitals and received consent from both Gangaram and Medicity where both have indicated to sign an agreement to start cashless services.
Others will have to sign on the same rates offered to the two.
In a press note, industry body CII said hospitals in Delhi have worked out the packaged rates for 42 procedures, submitted these to nodal TPA of PSU insurance companies, and are now waiting for a response.
"Once cashless is restored in the empanelled hospitals, in the second phase, Hospitals and Insurers along with other stakeholders of the health insurance ecosystem and the competent authority would work on a classification of hospitals, which would be agreeable to all," CII note added.
It quoted heads of few other corporate hospitals, saying they are yet to get response from Raksha TPA.