Here's some bad news for health insurance policy holders. Insurance companies may no longer foot the entire bill for your hospitalisation expenses.
Insurance companies have proposed that the insured should part-pay the bills during claims.
The proposal was discussed at a meeting organised by the Confederation of Indian Industry in Mumbai on Tuesday. The meeting was held in the backdrop of the recent stand-off between insurance companies and hospitals over inflated bills.
Among others, the proposals also included creation of six to seven categories of hospitals, based on their infrastructure, number of beds, speciality focus, and clinical and diagnostic capabilities. Health insurance companies will settle the claim based on a hospital's grade.
In other words, even the treatment cost in a small hospital for a particular illness could be similar to that of a bigger one with advance medical infrastructure and better facilities.
Fortis Healthcare CEO Vishal Bali, who attended the meeting, said: "The proposals, if implemented, will help in demarcating the charges of different hospitals, depending on the services and facilities provided. This will protect the interest of hospitals, insurance companies, third party agents and consumers."
At present, there is no set standard on the money a hospital can charge. This is largely a grey area, which led to a number of conflicts between hospitals and insurance companies in the recent past.
From July 1, public sector insurers had taken off over 100 hospitals from the list of the Preferred Provider Network. There were claims that hospitals were inflating bills exorbitantly leading to significant losses.
The insurance companies have been making losses, as they claim many small hospitals inflate their bills if a patient has cashless medical insurance. Due to this, the industry ended up paying Rs 11,000 crore (Rs 110 billion) on the premium collection of Rs 8,000 crore (Rs 80 billion).
CII to help restore cashless treatment
To ensure that customers get wider access through cashless facility, industry bodies like the CII will meet insurance companies through third party administrators to help them expand the PPN.
In a meeting with members of CII, National Committee on Healthcare and other stakeholders including AMC and the four PSU insurance companies-(New India Assurance, Oriental Insurance, United India Insurance and National Insurance Company) emphasised on higher level of consumer awareness which is required to ensure the portfolio is sustainable and beneficial to consumers and insurers.
"In order to keep Health insurance premiums affordable and viable, all stakeholders including consumers have to respect and maintain the integrity of the system," said M Ramadoss, New India Assurance chairman cum managing director.
Insurance companies have expressed their willingness to expand the network of hospitals within 90 days and address areas of concern.
After PSU non-life insurers delisted a few hospitals from their preferred list of hospitals, there has been an uproar. Insurers complain of unsustainable claim ratios due to escalating medical costs by high-end hospitals.
