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Will stop cashless facilities if grievances with insurance firms not solved: AHNA

Among key grievances of AHNA, according to its president Dr Bharat Gadhvi, is that charges for various procedures and hospitalisations have not been revised since the past five years, as against revision in prices made every year by private insurance companies.

By: Express News Service | Ahmedabad |
December 25, 2021 3:30:12 am
Nearly 100-125 hospitals and nursing homes of AHNA are expected to stop cashless payments after January 15, 2022.

Representatives of Ahmedabad Hospitals and Nursing Homes Association (AHNA), in a press conference in Ahmedabad on Friday, announced that it will stop cashless facilities in their member hospitals and nursing homes after January 15, 2022 if the association’s grievances with public sector insurance companies are not resolved by then.

Among key grievances of AHNA, according to its president Dr Bharat Gadhvi, is that charges for various procedures and hospitalisations have not been revised since the past five years, as against revision in prices made every year by private insurance companies.

Naming four public sector insurance companies specifically — New India Assurance, Oriental Insurance, United India Insurance and National Insurance — with whom AHNA members have been facing issues, Dr Gadhvi further added, “Medical care has evolved in these years as has life quality. MRI and CT Scan have become regular procedures and costs have gone up. The insurance companies refuse to pay out for disposables used, including disinfection charge or charge for gloves. Routinely discharge takes 30 minutes but patients with insurance from these companies take upto six hours or more or sometimes even delayed by a day. But these public sector insurance companies have not established or updated their infrastructure and as long as they do not do that, such problems will persist. We suggest patients should not avail services of these four companies if they desire proper healthcare services.”

Nearly 100-125 hospitals and nursing homes of AHNA are expected to stop cashless payments after January 15, 2022. A stop in cashless payment would mean a patient will have to pay for medical services at the hospital and subsequently will have to claim the expenditure incurred at the hospital from the insurance company upon providing receipts of medical procedures or services.

Other grievances include “delay of upto three to six months” in payouts to hospitals with arbitrary deductions, which are otherwise expected to be completed within 30 days according to AHNA, as well as there being no qualified doctor in third party administrators (TPA) to reasonably and justly assess claims and neither have tripartite agreements between hospital, insurance company and TPA is established. TPA is a company/agency/organisation holding a licence from the
Insurance Regulatory Development Authority (IRDA) to process claims.

Dr Manish Bhatnagar, chairperson of AHNA insurance committee and proprietor of Icon Hospital in Ahmedabad said, “We do not want to cause inconvenience to our patients but doing business with these insurance companies is bad business. We end up pursuing consumer litigations and it is bothersome for us to deal with this kind of inefficiency. There is no transparent process of deciding charges for hospitals. The last revision in rates was done in 2014 but hospitals received the approval by 2016. Usually public insurance companies revise rates once every five years. We are demanding uniformity in rates and agreements instead of some hospitals being given an ad-hoc arbitrary advantage by the insurance companies where they provide particular hospitals better rates.”

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