Concerned over the plight of patients after withdrawal of the cashless treatment facility by some hospitals at the behest of PSU insurance firms, noted heart surgeon Naresh Trehan on Monday said all-out efforts are underway to resolve the issue.
The public sector insurance companies had taken off from July 1 about 150 hospitals from the list of Preferred Provider Network (PPN) that provide cashless hospitalisation services to policy holders under the mediclaim scheme.
“Patents are suffering because of the problem. We are holding meetings with different stakeholders to resolve the issue,” Trehan, who is also the chairman of the CII Healthcare Council.
Pointing out that the cashless treatment in certain hospitals have been withdrawn only by the four PSU insurance companies, Trehan said several meetings between the insurers and the healthcare service providers have been held.
“We would be meeting them again to resolve the issue,” he said. He said another meeting is being held in Mumbai on Tuesday.
The four insurance companies — New India Assurance, United India Insurance, National Insurance and Oriental Insurance — are believed to have stopped the cashless service because of alleged over-billing by some private hospitals.
Narottam Puri, a noted ENT specialist and member of Ficci’s committee on health services, described the steps taken by the PSU insurance companies as ‘retrograde’.
He questioned how the best private hospitals in the country could suddenly become bad and taken out of the network of entities providing cashless treatment facility to insured persons.
On the allegations of over-billing, Puri said: “These issues can be sorted out across the table.”
I would like to share my experience too. My wife was required to undergo angioplasty; doctors said it would cost about Rs.12000/-. While undergoing the proceedure the consulting doctor stopped it midway saying a heart bypass was a certainty in the yet to be concluded test. Yet after the bill was received, the hospital had charged Rs.20000/-+. Total claim had been put to TPA for Rs.60,000/- (inclusive of other charges). While in hospital, doctors of every hue of learning visited the patient, leafed over the papers made notings of his visit and when asked for his opinion on a particular matter, turns around and remarks “Ask the doctor under whose care you have been admitted”. If that was the ase, why the hell did he visit the patient and log his charges. After the claim was settled,we got the shock at the next renewal of mediclaim policy. For Rs.60,000/- claim we lost noclaim bonus of Rs.150,000/-. Why? Initially the dot-headed agent says it is based on goverment instructions, later, on asked for wrtten govt. memo, he produces the printed Ins. Co. policy document [Mediclaim Policy 2007](which was not given to us at the time of renewal) which explains why the noclaim bonus was cancelled. Find me an idiot born if knowingly he would claim Rs.60000/- and lose Rs.150000/- in future claims. Agents are just commission collecting intermediaries;they do not keep themselves abreast of changes and hence are not able to assist insured clients in making proper claims. Why they should be paid commission on MEDICLAIM policy beats me. MEDICLAIM policy is bought, not sold. Lot more can be written but this is not the forum to give full views on mediclaim as the system prevails now in India.
I would like to share my experience had in a noted Private Nursing Home of kolkata-in the year 2007-while make a PCOD treatment of my wife.Initially after an investigation by the Doctor the concerned officials make an estimate for the said operation in the tune of 25,000/-,however, as soon as I had disclosed that the patient has a mediclaim policy-immediately after they gladly took the note of necessary papers and started the necessary formalities. After the said operation-which was however as per my wife’s version had nothing substantially done-as the operating team had spent maximum time to joke with each other-had submiteed some papers-wherein the total bill produced for reimbursement to the TPA firm in the tune of 40,000+ amount -when I asked the officials why such an exorbitant bill is supposed to be produced to the TPA firm the officials told the TPA firm is used to reduce the bill for a considerable amount-moreover-as the amount so receivable is a’white income & taxable one’ that’s why the doctors used to charge a higher amount for operation. I got stunned on hearing the same.
Hospitals are not the only entity in the mediclaim mess that it is in. Alongwith hospitals’ malpractice, doctors within the hospitals and in private practice display rougish behaviour and the extreme anti-insured practices of the insurance companies particularly with regard to senior citizens requires to be condemned most vociferously. Hospitals give more care not necessarily good care. Doctors first ask their patients whether they have mediclaim cover; reasons behind this is easy to guess. Insurance companies resort to “underwriting” instead of paying medical bills.Insurance companies compile mediclaim policies but do not inform the insured the changed terms and conditions. When insured question some unfair practice, the policy document is thrown to them. IRDA has prescribed “File & Use” guidelines which require certification from from a legal counsel of Insurance Company on the simplicity of the policy wording. in actual reality the Insurance companies “File” (not hand over the document to insurer) and “Use” the document when claim arises. “Simplicity” in action by insurance company and “misleading” the insured. An excellent epithet on the grave of a senior citizen.
Are we Indians always at the mercy of such PSUs? Simply taking out 150 hospitals from the list of cashless treatment hospitals will not solve the problem. This needs investigation of A class surveyors and PSUs itself. Why and how overbilling is done by hospitals is a big question? Strict action should be taken against the hospitals and not the insured because an insured does not gain any money against overbilling by certain hospitals as alledged.