Bombay, Jaslok and Fortis hospitals worked out a consensus, and now South Mumbai’s Cumballa Hill and Andheri’s Kokilaben Ambani hospitals are ready to follow suit.
In a major breather to patients, more five-star hospitals are now willing to join the Preferred Provider Network (PPN) of the public sector insurance companies that will enable patients to claim cashless medical facilities.
South Mumbai’s Cumballa Hill Hospital recently joined the network and Andheri’s Kokilaben Ambani Hospital is ready to follow suit. Earlier, Bombay, Jaslok and Fortis hospitals have worked out a consensus and joined the PPN.
In 2010, five-star hospitals had banned cashless insurance for patients who had taken policies from the four public sector insurance companies – New India Assurance, United India Insurance, Oriental Insurance and National Insurance – after they came up with PPN and fixed rates for all medical procedures. The hospitals argued that their expenses vary from location, equipment and services, and that they cannot fix prices for all procedures.
After a series of meetings and discussions with the General Insurer’s Public Sector Association (GIPSA), however, private hospitals are now willing to join after the insurance companies are readily moulding the packages of procedures.
“Earlier, the decision of GIPSA was ad hoc. Now they are being more practical and understanding,” said Dr Niraj Uttamani, CEO of Cumballa Hill hospital. “The GIPSA team considered our problems such as range of rooms, cost of consumables and so on. They have also committed to give us the payment of a cashless case within 30-45 days,” said Uttamani, adding that patients were extremely hassled because of the non-availability of cashless facility.
The tussle between the hospitals and insurance companies began on July 1, 2010 after the governmentowned insurance companies started the PPN programme to put a stop to inflated claims made by the hospitals under cashless insurance. Under PPN, the rates of all surgeries were fixed by the insurance companies.
The hospitals, however, did not agree with the rates stating that they were extremely low and that the insurance companies had not considered the facilities, locations and class of the hospitals. For smaller hospitals and nursing homes, the rates were slashed up to 30 per cent and for bigger hospitals, they were reduced to less than 50 per cent of what they charged earlier.
“Gradually, hospitals and the insurance companies are redesigning packages that are suitable for both parties. Kokilaben Ambani Hospital, too, has almost finalised the packages and will soon start their cashless service,” said Krishnakant Mehta, executive office of Association of Hospitals (AoH), a body of more than 60 major private hospitals in the city.
“More hospitals are in talks and may follow suit,” he added. Experts say the development will benefit lakhs of patient, as barely 15 per cent market is owned by 16 private insurance companies, while the four public sector companies own the major 75 per cent of medical insurance market.