If you have a mediclaim policy that entitles you to cashless facilities, here is some bad news. You will no longer be able to get these facilities at high-end hospitals like Apollo, Fortis, Ganga Ram, Max or Medicity in Delhi, the national capital region (NCR) and the metros of Mumbai, Bangalore and Chennai.
All insurance companies providing mediclaim facilities, a cashless health insurance, have stopped direct payment of treatment charges to 150-odd high-end hospitals in Delhi and NCR alone from July 1. If you now go to any of these hospitals, you will have to pay from your pocket despite having a valid mediclaim policy with all premiums paid. You will then have to reclaim the amount from the insurer with no guarantee that the entire amount would be reimbursed.
At least 18 insurance companies, including the four public sector entities, have taken off more than 150 hospitals in Delhi and NCR from their designated list for the cashless facility. This facility will now be available at only 100-odd hospitals, none of them from the big chains. There has been a similar axing of hospitals from the list in other cities.
What has forced these insurers to take this step is the fact that they have been bleeding badly. They are making an estimated loss of Rs 1,500 crore annually on a yearly premium collection of Rs 6,000 crore on mediclaim policies across the country,
These 18 insurance companies had so far been providing cashless services at over 3,000 hospitals pan-India. However, a recent study carried out by the TPAs found that only 350 of them or roughly 11% were consuming more than 80% of the total claims.
It was also found that customers were overcharged for each hospitalization, irrespective of the treatment, and were left with very little funds for their next treatment. This is intended to discipline the hospitals who are overcharging a customer.
Segar Sampath of the New India Assurance Co Ltd said, "TPAs have been asked to convey the fresh list of hospitals to individual policyholders as also the new packages available."
These insurers have worked out treatment packages and depending on the hospital's infrastructure, the lower or higher rate will be applicable.
For instance, hospitals that are part of the big chains charged Rs 58,000 on average for a gall bladder operation. Now, according to the new package deal, a hospital would be offered anywhere between Rs 30,000 and Rs 48,000 for the same. Similarly, for a cataract operation, the average payout was Rs 35,000. The new deal provides for a maximum of Rs 24,000, while it would be Rs 14,000 if the surgery were done at a smaller set-up.
The insurers, said have been negotiating with the big chains for the last six months in an attempt to persuade them to accept the packages. So far, however, none of them has responded positively, forcing the insurers to take this drastic step.
The insurers have identified the four metros of Delhi, Mumbai, Bangalore and Chennai to start with the new package deals. The scheme would then be rolled out across the country. These four metros account for almost 50% of the Rs 6,000 crore annual mediclaim premium collected by the 18 insurers. Overall, the premium collection on health insurance is estimated to be upwards of Rs 9,000 crore.
