Health insurance cashless dispute getting resolved: IRDA

CHENNAI - 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”.

“The issue is getting resolved. There are more hospitals in the network of government owned insurers - over 400 - as compared to around 300 prior to the dispute,” IRDA Chairman J. Hari Narayan told reporters here.

He was here 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.

The four government-owned non life insurers had earlier delisted major hospital chains from offering cashless hospitalisation facility for their health insurance policy holders on the ground that the hospitals are over charging the patients.

Asked whether it is time to have a regulator for the healthcare sector, he said: “A parliamentary standing committee had earlier recommended in favour of a regulator for the health care sector.”

Meanwhile, the Confederation of Indian Industry (CII) has said none of the major super speciality hospitals have signed with the Raksha TPA (third party administrator).

On Aug 12, CII members held a meeting with Raksha in Delhi. The hospitals in Delhi have worked out the packaged rates for 42 procedures and submitted to the TPA.

According to CII statement issued in New Delhi, its members are waiting for a response from the insurers and 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.

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.”

According to Sanjeev Bagai, CEO, Batra Hospital and Medical Research Centre, 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.

“This grading or categorisation of hospitals should then translate into pricing of procedures in each grade. Premature conceptualisation or inference of this complex process, must be avoided,” he said.