Caught in the standoff between insurance companies and private hospitals over ‘low’ treatment rates, patients have been denied cashless treatment since April this year. Talking about the problems they face due to lack of ready cash, patients have urgently sought a third-party mediation. The hospitals’ contract with public sector insurance companies had expired on March 31 and has not been renewed.
The hospitals have urged the companies to revise the rates offered. Since then, patients are being forced to pay cash and claim the reimbursement later. Nirmala Savadekar, photographer and painter who is suffering from a chronic kidney disease and requires dialysis thrice a week, has to pay Rs 3,500 per session. “I need 13 sessions in a month, a monthly sanction for which was being provided by health service facilitator Raksha TPA. However, due to the stand off, now I have to pay the amount per session. At times, I do not have ready cash available. It is really tiresome. There is need for a speedy solution. If private hospitals and public insurance companies cannot resolve the issue, a third-party should intervene and decide the matter,” he said.
Mitesh Pawar, a businessman whose wife was admitted to Ruby Hall Clinic two weeks ago, too faced a tough time when the hospital asked him to pay for treatment in cash. “I had to take out money using my credit card. The hospital did offer another solution, where a start-up firm was offering a zero per cent interest-free loan. I did avail the loan but it is frustrating. I have a mediclaim policies with two general public insurance companies but I cannot avail the benefit of a cashless transaction,” he said.
Dr Sonia Basu, founder of Health Fin — a start-up that facilitates loans for patients, said they have tied up with several hospitals, including Ruby Hall Clinic, Jehangir and Poona Hospital, and have set up helpdesks for such patients. “So many patients have approached us and feel helpless as they cannot immediately pay the amount required by the hospital. We have tied up with a non-banking financial company to facilitate the loan,” Basu said. So far, we have processed as many as 35 applications from patients, she added. Sarad Powar, who works with a city-based firm, had to shift his father from Sahyadri Hospital in Hadapsar to Ruby Hall Clinic, for an angioplasty. Pointing out that it was not fair to avail another loan, when he already has a mediclaim policy with a public insurance company, Powar said, “I have no choice. I have taken a personal loan and do not have ready money. I will raise the amount through friends and relatives.”
Bomi Bhote, chief executive officer of Ruby Hall Clinic and president of Association of Hospitals in Pune, said they had urged the companies to revise the rates offered by them and had reiterated that it was not feasible to provide treatment at low rates for 141 procedures. For instance, the rate offered for an Anterior Cruciate Ligament tear (shoulder decompression) is Rs 68,000, whereas in Bengaluru insurance companies have offered Rs 90,500 for the same procedure. Why this disparity? asked Bhote. According to Vijay Khirdikar, officiating regional in-charge at The New India Assurance Company Limited, “We already have 60 empaneled hospitals, and some others have agreed to our rates too. This is a period of transition and there are bound to be some issues. However, reimbursement of the medical claim is done within three days of the sanction. Still, we are working on a solution with other hospitals,” he said.
Meanwhile, some small hospital owners, on the condition of anonymity, claimed that insurance companies were dictating the terms, while it was made to look like hospitals were refusing patients. “Many small hospitals are losing patients because of this silent clash with public sector insurance companies,” said an orthopaedic surgeon with a 50-bedded hospital in the city. The public sector insurers, including National Insurance Company Limited, New India Assurance Company Limited, Oriental Insurance Company Limited and United India Insurance Company Limited, have negotiated special package rates from many hospitals across the country. Cashless facility for these procedures is provided only in the GIPSA (General Insurers Public Sector Association of India) network hospitals.