03 August,2010 07:01 AM IST | | Anushree Chatterjee
Major insurance companies have withdrawn cashless hospitalisation facilities. Lack of transparency on the part of the hospitals is allegedly to blame. Active! gets in on the debate
Public sector insurance firms including United India, New India, Oriental Insurance and National Insurance terminated their cashless mediclaim services from some of the best hospitals in major cities, including Mumbai, early last month.
Insurance companies dishonoured bills submitted by hospitals to settle patient claims since they had allegedly been presented with inflated bills. Moreover, companies claim, hospitals often over-charge when they learn that a patient has an insurance cover.
Hospital staff are unhappy with the decision and suggest that insurance companies investigate the matter thoroughly before scrapping the facility.
Dr Sujit Chatterjee, Gynaecologist and CEO of Dr LH Hiranadani Hospital, Powai, says, "This is only an allegation, not a fact. If the insurance guys have a grouse, they should settle it through dialogue.
All hospitals cannot be painted with the same brush. A vast majority have a transparent billing system."
Insurance advisor for the last 24 years, Zeenat S Jagani approves of the move. "Insurance settling through cashless policies has been a hassle for both the company and the patient. It's a complicated and roundabout way of settling the claim, leading to trouble for the insured party."
What is cashless hospitalisation?
It is a facility that takes care of a patient's hospital charges without the hassle of on-spot payment. If a patient gets admitted to a hospital that has a tie-up with his chosen insurance firm, the patient is not expected to make payments. Payments are taken care of through a direct deal between the hospital and the insurance firm.
PROS
Admission and treatment not hampered
Policy covers over 3,000 locations in India
Calls for good financial planning
CONS
Over-charging by hospitals
Unclear rate structure as standard rates can't be verified at every instant
Patients end up paying over and above insurance amount
