BENGALURU: In a relief to patients, the friction between public sector insurance companies and private hospitals will soon cease to be. This would mean that the cashless services provided by the latter to patients, with insurance, would remain unchanged, as opposed to the warning issued by the hospitals.
Around 140 medical procedures are covered by public insurance firms. A recent meeting of Private Hospitals and Nursing Homes Association (PHANA) and General Insurance Public Sector Association (GIPSA) seems to have ended on a positive note on Wednesday.
“At the moment, talks (with GIPSA) are cordial about the tariffs. The MOUs between private hospitals and insurance firms were not renewed owing to them. As many as 70 hospitals were impacted,” said PHANA president R Ravindra.
Speaking to The New Indian Express principal coordinator of Federation of Healthcare Associations (FHA) Dr Nagendra Swamy said, “The outcome of the meeting seems to be positive and in a matter of just two days these issues will be resolved.”
Members of PHANA, who had convened a meeting the previous week, had decided to discontinue cashless treatment for patients, who avail insurance from four public sector insurance firms, from June 1. “This was because the latter had proposed unrealistic tariffs (as reimbursement to hospitals),” said Ravindra.
The friction between private hospitals and public insurance companies would have affected patients, had they relied on them.
However, matters are likely to be resolved between the two parties, with the insurance firms agreeing to most of the points expressed by private hospitals.
Most of the claimants for the public insurance services, as medical practitioners claim, are above poverty line patients. However, sources from the field said there are many hurdles among patients in the below poverty line (BPL) category.
“Cashless insurance under the Ayushman Bharath and Arogya Karnataka, or even the state government’s flagship health insurance scheme Vajpayee Arogyasri Yojana are yet to deliver on their promises and reimbursements. While these schemes are supposed to help members of the lowest economic strata, it takes at least three days for the credit offices at the hospitals to get an approval from the nodal agencies,” said some doctors of private hospitals. It takes anywhere between three days to a week to get an approval, even for emergencies, they added.
In case of procedures that require immediate treatment, like fractures and bleeding, patients have to be their own guarantors and are even made to take responsibility for the credit approval by signing forms, added sources. Some have to make payment upfront as a guarantee to hospitals that the rest will be paid later. In case they cannot pay, they are sent back to government hospitals for immediate attention.