Irda On Health Insurance Cashless Dispute

The Insurance Regulatory and Development Authority (IRDA) Friday said the issue of offering cashless treatment under health insurance policies issued by the four government-owned general insurers ‘is getting resolved’. IRDA Chairman J. Hari Narayan said that prior to dispute there were only 300 government owned insurers as compared to 400 now.
The four government-owned non life insurers had earlier delisted major hospital chains from offering cashless hospitalization facility for their health insurance policy holders on the ground that the hospitals are over charging the patients.
He was in Chennai to launch the country’s first health cum life insurance product introduced by the city-based Star Health and Allied Insurance Company Ltd partnering with private life insurer Shriram Life Insurance Company Ltd. when he clarified.
There are talks of creation of separate regulator for the healthcare sector. Also, Confederation of Indian Industry (CII) has said none of the major super speciality hospitals have signed with the Raksha TPA (third party administrator).
CIIs members are waiting for a response from the insurers and the TPA since the meeting Raksha in Delhi. As on August 12, the hospitals in Delhi have worked out the packaged rates for 42 procedures and submitted to the TPA.
Once cashless is restored in the empanelled hospitals, in the second phase, hospitals and insurers along with other stakeholders of the health insurance ecosystem and the competent authority would work on a classification of hospitals, which would be agreeable to all.

The other side:

Shivinder M. Singh, managing director, Fortis Healthcare said ‘There will always be a differential in the levels of care and services provided by hospitals for a single type of illness. This differential is a function of structures, processes and outcomes. A scientific analysis of all these parameters is essential to grade hospitals.’
Sanjeev Bagai, CEO, Batra Hospital and Medical Research Centre said, ‘This grading or categorization of hospitals should then translate into pricing of procedures in each grade. Premature conceptualization or inference of this complex process must be avoided’. It is essential that a comprehensive exercise be undertaken of grading hospitals based on their infrastructure, clinical expertise, technology base, clinical outcomes, competency of para-clinical man power, accreditation and standards of care is done.

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