Cash Missing In Cashless Insurance
By Amit Bhanot |
9/27/2010 2:50 PM Monday
You must no doubt be aware of the recent controversy involving insurance companies and the elite club of hospitals regarding the subject of cashless insurance. Apart from whatever has been reported by the media, there still remain a lot many factors that need to be clarified. This especially concerns those who already have a mediclaim policy and are now unsure of how this issue will affect their interests. As such, we at DSIJ decided to get to the bottom of this matter and provide pointers to our readers to help them understand how they should deal with this new problem.
The cashless insurance row got kicked off in the month of June when some insurance companies, especially the four public sector general insurance companies, vehemently denied cashless facility to their customers if they availed of medical treatment in five-star, corporate-structured hospitals. This was because the insurance companies felt that these hospitals were overcharging those patients with medical insurance.
There were claims that the amount charged was at times as high as 150 per cent of the premium paid by the customers. It was further alleged that such hospitals usually have two different kinds of rates for their patients depending on whether they are covered by an insurance policy or not. “Certainly it is common knowledge that there are different rates being charged for the patients with and without insurance. This has resulted not only in losses for us but it affects the customer too because he or she may not have enough balance left to take care of any future hospitalisation in the same year,” points out Dr R K Kaul, CMD, Oriental Insurance Company.
To arrive at a solution, the PSU insurance companies requested these elite hospitals, a majority of which exist in NCR, Mumbai, Chennai, and Bangalore, to reduce their rates at least by 20 to 40 per cent. This demand from the insurance companies was immediately rejected by the hospitals on the ground that they give quality service to their patients and that there was no question about any sort of ‘extra’ charges. “The insurance companies have to realise that different hospitals have different levels of infrastructure, expertise, etc. and that the same tariff cannot apply to all. There needs to be a logical gradation and categorisation of hospitals which will allow for the establishment of fair tariffs,” says Ranjana Smetacek, Director (Marketing and Corporate Communication), Fortis Healthcare.
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