COIMBATORE: The much-touted government medical insurance schemes are of no avail to the public as several empanelled hospitals allegedly don't pass on the benefits to the insured.
A consumer forum alleged some hospitals in the panel of central and state insurance schemes are forcing even patients eligible for cashless treatment to pay up before treatment.
It sought the attention of the state and central governments on the selective implementation of the Prime Minister's Jan Arogya Yojana (PM-JAY) and Chief Minister's Comprehensive Health Insurance Scheme (CMCHIS).
In a petition to the Chief Minister's special cell and the Prime Minister's Office by Citizens' Voice Coimbatore (CVC) president CM Jayaraman said eligible patients are guided on payment procedures.
"A 70-year-old retired bank employee who was admitted in a private hospital on Avinashi Road for an emergency treatment expressed to avail the cashless insurance benefit, but the hospital management demanded his family members to pay cash before commencing treatment and advised them to claim reimbursement from the government later by themselves," he said.
The patient had PM-JAY and CMCHIS insurance cards.
"Eventually, the family members spent around Rs 1.52 lakh for the treatment and could not avail the medical insurance as it was denied by the hospital. It was not a single incident: many private hospitals are forcing patients to pay cash first despite having the governments' insurance coverage," he added.
"Instead of providing the core benefit of cashless treatment, patients are often compelled to pay the full treatment cost upfront, with the false hope that they can get a reimbursement from the government. The patients are left with no other options. This practice by the hospitals is against the objectives of the schemes to provide cashless medical treatment. Since a direct patient reimbursement channel does not exist, this practice results in confusion and the effective denial of immediate care for those who cannot afford large initial payments," he added.
The forum demanded the issuance of a clear circular to all empanelled hospitals, unequivocally affirming that cashless treatment must be provided immediately to all eligible beneficiaries under the PM and CM Health Insurance Schemes.
