Mumbai: State-owned insurance companies
today agreed to restore cashless treatment facilities in big
private hospitals on case-to-case basis, a development that
will benefit lakhs of mediclaim policy holders.
"The insurance companies have decided to restore cashless
facilities on a case-to-case basis. We discussed ways of
making people part of the facility and how the reimbursements
to them can be revived," head of health insurance vertical at
ICICI Lombard Sanjay Datta told PTI after a CII-initiated
meeting between insurers and the healthcare industry.
The state-owned insurance companies, Oriental Insurance,
New India Assurance, National Insurance and United Insurance,
have also agreed to expand the network of hospitals providing
cashless treatment facility (Preferred Provider Network) for
the benefit of mediclaim policy holders.
"The insurance companies reiterated their current
position of willingness to expand the PPN (Preferred Provider
Network) and in 90 days work with CII and other stakeholders
to address areas of concern," CII said in a statement.
Industry body CII called a joint meeting of the insurers
and the healthcare industry to resolve the impasse following
withdrawal of cashless treatment facility at about 150
hospitals by four PSU insurance companies from July 1 on
allegations of over-billing.
Speaking at the meeting New India Assurance CMD M
Ramadoss said hospitals and customers need to "respect and
maintain" integrity.
"In order to keep health insurance premiums affordable
and viable all stakeholders including the consumers have to
respect and maintain the integrity of the system," he said.
As regards the patients seeking treatment under mediclaim
scheme, Fortis Hospitals CEO Vishal Bali said they would have
to seek reimbursement for claims for treatment in delisted
hospitals.
The insurers and the healthcare industry also agreed for
gradation of hospitals for the purpose of mediclaim
facilities. The hospitals would be graded in three categories
-- A,B and C-- on the basis of infrastructure facilities and
specialties.
The grading, according to S Gopalakrishnan, New India
Assurance General Manager, will not have any impact on the
premium being paid by policy holders but would help the
insurance companies in cutting down losses.
"Following gradation, there will only be a change in
contract between the insurers and the hospitals", said Datta.
Besides the insurance companies, the meeting was attended
by representatives of Fortis, Max Healthcare, Apollo
Hospitals.
-PTI
