Finance Minister Pranab Mukherjee on Monday allayed fears of withdrawal of the cashless mediclaim facility by public sector general insurance companies, saying these firms have not done away with these schemes and are only standardising the rates for various hospitals.
“The public sector general insurance companies have not, I am emphasising on, have not revised or withdrawn the facility of cashless treatment,” Mukherjee said in the Lok Sabha.
From July 1, public sector insurance companies had suspended about 150 hospitals from their list of preferred provider network healthcare companies which provide cashless hospitalisation services to policy holders under the mediclaim scheme.
This was interpreted by some as withdrawal of the cashless mediclaim facility by these insurers. “The companies have started rationalising empanelment of hospitals and the standardisation of rates and specified procedures followed by these hospitals,” Mukherjee said.
Last week, insurance regulator IRDA chairman J Harinarayan had expressed hope that hospitals and insurers will be able to arrive at a mutual solution.
The state-run insurers had alleged that the hospitals were billing patients higher if they came under mediclaim, whereby the claims were higher than the premium received by the insurers.
At a meeting of private hospitals and public sector insurance companies last Friday, both the parties had agreed to restore the cashless treatment facility under the mediclaim policy within 10 days.
The hospitals have already restored the cashless facility for emergency, ICU, cardiac care and trauma cases.
Today we face enormous problems with the TPA, when treatment is taken out side of cash less network hospitals for reasons not convenient to the insured. TPA arbitrarily deduct amounts as they deem fit saying it is reasonable. What is the definition of REASONABLE? When expendititure is incurred then deducting the amount on the one hand, but not giving the details of claim passed by them is another problem created by TPA. When an insured gets a Cheque for a lesser amount than what is claimed, then he is entitled to get his claim form duly corrected giving the reasons for the short payment. If TPA behaves this way then it is highhandedness and needs to be looked into. There are always personal bias in the mind of TPA who pass the claims. Larger thinking should be done and Insured has a right under the Insurance contract to know how his claim is paid and the reason there of.