The mistrust between hospitals and health insurance companies had come into light recently after the later restricted the cashless payment facility offered to patients at hospitals, alleging that hospitals billed insured patients more than the uninsured ones. Insurance companies have stopped payment to some leading hospitals though insured patients had taken treatment. Now patients have to pay first and then claim the amount from insurance companies. This is mainly due to insurance companies contention that some of the first rated hospitals are charging more amount than reasonable amount for the treatment thus making holes in the profitability of insurance companies. In order to avoid stand off, the leading hospitals under the guise of AOH (Association of hospitals) have come out with some solution like differential rates for different hospitals based on quality of treatment and time of treatment.
Hospitals have opposed the “one size fits all” approach being suggested to tackle the stand-off with insurance companies, after they restricted the cashless payment facility extended to patients to certain hospitals. The rate of treatment differs depending on various factors, including location, Quality of treatment, facilities in rooms, city in which situated or the type of speciality (tertiary or secondary care hospital etc). Hospital of top-brass welcomed being graded by the National Accreditation Board for Hospital and Healthcare Providers (NABH) and added that a price-band on treatments and rates across hospitals, specialities and location could help weed out the ambiguities in the system and help insurance companies to have satisfaction on the rates of hospitals. AOH says that the govt should take note of this while discussing with insurance companies and hospitals. The AoH is a platform of 56 private hospitals and includes players such as Hinduja, Jaslok, Breach Candy and Hurkisondas hospitals.
Some progress is going on and there is hope that deadlock will be resolved quickly
C. R. Venkata Ramani