For fair claims,insurance companies,govt to have details of hospitals

In a bid to make the Rashtriya Swasthya Bima Yojana more transparent in Uttar Pradesh,the Samajwadi Party government is planning to introduce markers for empanelled hospitals of the scheme.

Written by Express News Service | Lucknow | Published: May 13, 2012 3:09 am

In a bid to make the Rashtriya Swasthya Bima Yojana (RSBY) more transparent in Uttar Pradesh,the Samajwadi Party government is planning to introduce markers for empanelled hospitals of the scheme.

Further,the infrastructural details of the hospitals will also be available with both the insurance company as well as the state government,which would make it more difficult for fake claim of insurance amount.

As the state government has already decided to introduce 64 KB smart cards for the scheme in place of 32 KB memory smart cards,the infrastructural details of each hospital will now be available for scrutiny with each corresponding insurance claim.

“With the corresponding infrastructural detail,it will be possible for us to trace fraud case. For example,if a 10-bedded hospital claims an insurance amount for 11 patients at the same time or if a hospital with no gynaecologists claims to treat a patient for gynaecological ailment,we will be able to trace it immediately,” said Alok Kumar,CEO,RSBY.

Kumar also said that after survey of the hospital facilities in all districts,the department will make it mandatory for the insurance provider to empanel at least a certain number of hospitals in each district. The department is also developing internal bench marks to judge if the empaneled hospitals are of the minimum expected standard,said Kumar.

Earlier this week,the state government decided to introduce 64 KB smart cards under RSBY as per the Centre’s plans to increase the memory space of the smart cards across the country. The card with higher memory has several benefits,including saved cost of making fresh cards each year as the same card can be renewed. However,the new card is expected to cost Rs 10 to 15 per unit more,and since the tender process of RSBY for the year has already been completed,the extra burden will have to be borne by the same insurance companies.

Three insurance companies,ICICI insurance,United Insurance and Oriental Insurance were awarded tenders for providing the insurance coverage for all the districts in six clusters.

“While Oriental and United Insurance are ready to introduce the new card in all their clusters,ICICI is not agreeing for the new cards in one of its three clusters. If it does not agree,we will have to go for fresh tendering in the said cluster,” said Kumar.

However,with the transition of the RSBY from 32 KB to 64 KB cards,the entire procedure will be delayed by a month,which was to be started from June 1 in 41 districts where the insurance policy has expired,said Kumar.

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