Pvt hospitals deny health cover by state-run insurers

Mumbai: Come January 15 and all the 125 private hospitals and nursing homes in Ahmedabad will close cashless facility of all the four state-run insurers-New India, United, Oriental and National. The call for closure of the cashless facility has been given by the industry body, Ahmedabad Hospitals and Nursing Homes Association (AHNA). The reason behind this being that the Government insurers have not revised the charges for private hospitals for the last five years. Talking to Bizz Buzz on condition of anonymity, an insurance official said that everything was transparent from insurers on the health insurance issue, whereas there was lack of transparency on behalf of hospitals. Hence on what ground are they (the hospitals) are alleging against the state-owned non-life insurers on the issue, he asked.

Another retired official said that in case it happened so, then the insured will have to first pay the bills to the hospitals and insures will reimburse against those medical bills. The scuffle between insurance companies and private hospitals will put life of thousands of patients, who are currently undergoing treatment in various hospitals in Ahmedabad, at risk.

As many as 125 private hospitals in Ahmedabad city have decided to discontinue cashless facilities for insurance holders of New India Assurance, Oriental Insurance Company, National Insurance Company and United India Insurance since January 15. The four government-run insurers have not made any revision of hospital charges for the last five years, according to AHNA. They are forced to make this decision without regularly resolving some issues. Hospitals in Ahmedabad as well as nursing homes will close their cashless facility without any redressal despite numerous representations from government insurers, an AHNA spokesperson said.

AHNA President, Dr Bharat Gadhvi said: "New India, Oriental, National and United India are rudely administered." Payment against claims by government-owned insurers is very late. Despite the 30-day limit, no timely payment is made by any government insurance companies. This is a serious offense under the MSME Act. They do not give the same answer and talk of talking in Delhi or Mumbai office. If people want good facilities, stop taking insurance from these four companies. If any questions are not answered, cashless facilities will be closed by private hospitals in Ahmedabad from January 15, he said.

Insurance companies' premia have doubled to tripled during last five years. Government-run insurers have not revised the charges for the last five years. In five years, the premia of non-life insurance companies have doubled or tripled during this period. Due to the huge increase in the cost of all services at the hospital as well as the staff, the cost of treatment of the insured patients of the government-run insurance companies is unaffordable against the charges. Hospitals as well as nursing homes have so far run the gamut created by government-run insurance companies. These insurers have forced the association to take this serious step after much internal discussion. The seniority of the doctor is also not taken into consideration while determining the charge.

Officials at government-run insurers emphasize that hospitals be charged 40 per cent less when they approached them.