PATIENTS belonging to the large middle-income group, unable to avail cashless admission in hospitals through medical insurance until now — as it remains unavailable at small nursing homes such patients usually visit — may soon be able to avail the facility.
As many as 150 city and suburban nursing homes are in talks with insurance companies to restart the cashless admission services. In 2010, insurance companies had put a stop to cashless admission in most nursing homes across Mumbai after irregularities in medical bills became rampant.
A cashless scheme is a service wherein an insured patient’s bill is paid directly to the hospital by the insurance company, meaning the patient gets admitted and treated without immediately having to pay. Nursing homes in Mumbai now offer the reimbursement insurance scheme where an insured patient first pays his medical bills and later gets reimbursed from the insurance company.
According to Dr Niranjan Agarwal, owner of Salasar Nursing Home in Bhayander, talks have started afresh with New India Assurance Co Ltd to empanel 150 nursing hospitals in Mumbai for the cashless service.
“In 2010, the insurance companies had problems with operations of small nursing homes. There were no standardised procedures for record keeping and there were different packages for insured and non-insured patients. A preferred hospital list was created in which insurance companies chose a handful of hospitals for continuing the cashless scheme,” Agarwal said, adding that almost all nursing homes in Mumbai have been out of the cashless scheme since 2010.
With an aim to introduce uniform standards, nursing homes have now come together to form a voluntary accreditation body called the Forum for Enhancement of Quality in Healthcare (FEQH), on the lines of Quality Council of India (QCI), a central government accreditation board.
“We started FEQH, which is QCI’s Mumbai chapter. It follows norms laid down by QCI and will also follow transparent packages for patients apart from maintaining uniform records and complying with basic healthcare norms,” Agarwal said.
The FEQH, which will regulate its 150 accredited members, this year made an attempt to restart cashless service promising to regulate fair practice in nursing homes. New India Assurance’s General Manager, Segar Sampath Kumar, said, “Now discussions are ongoing to start cashless again in nursing homes. The agreement is going towards its final stages.”
Dr Sudhir Naik, president of Association of Medical Consultants (AMC) and owner of Guru Nanak Nursing Home, Goregaon, said that after cashless scheme was suspended, several middle-class patients started preferring hospitals over his 15-bedded nursing home. “Nursing homes are cheaper than big hospitals. But with the cashless service gone, several patients are forced to go to big hospitals,” he said.
Health insurance experts say the cashless service will “definitely help middle class patients”, but warn against possible irregularities.
Bhaskar Sharma, Managing Director at State Bank of India, told The Indian Express, “There has to be an understanding of the pricing between insurance companies and small nursing homes. Nursing homes’ quality differs from one another which also needs to be examined.”
Even Kumar said that with talks starting afresh, several discussions are underway to avoid any irregularities that happened in 2010.