Upto 30.6.2010, all insurance companies providing medi-claim policies used to offer cashless health insurance in which the affected insured patient can get himself /herself admitted in a approved high end hospital (150 beds or above ) or any other approved hospitalsand get treatment without any major payment. But from 1.7.2010 onwards, most of insurance companies (18 including three Public Sector Undertakings like oriental, general insurance etc(except national nsurance) had stopped this facility in major cities and some II tier cities in respect of high end hospitals like Apollo, Fortis , Max etc. This list differs from place to place. The patient has to pay first to the hospital and then reclaim this amount from the insurer. There will not be any guarantee whether entire amount will be paid as reimbursement. The cashless facility will be offered only in recognized hospitals where facility of 100 beds or less is available.
The reasons for this step are the high cost involved in treatment in these hospitals which caused insurance companies to lose much. Against yearly collection of 6000 crores, the claim was paid nearly 7500 crores this making loss of 1500 crores. The claims settlement ratio indicated that big hospitals (11% composition ) grabbed 80% of claims.
In order to bring some discipline on the side of big hospitals, this step has been taken by all insurance companies. Now they want the big hospitals to specify new package deals for any operations. For example, for gall bladder operation, they can charge around 35000 in place of Rs.58000.For cataract operation, they can charge around 20000 against 35000.
So people taking insurance cover may ask for fresh list of approved hospitals for cashless facility so that they will not be in soup when any contingency arise.
C. R. Venkata Ramani