Cashless treatment for insured- solution is forthcoming soon

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



2 thoughts on “Cashless treatment for insured- solution is forthcoming soon

  1. ABUSES EXISTS. If they were hiring appropriately trained staff and providing ongoing staff training and support, including criminal PROSECUTIONS AS WELL you’re not going to have this many reported incidents IN HOSPITALS, OLD AGE HOMES. The Ontario Excellent Care for All Act, requires that all errors be reported directly to hospital administrators. in Hospital acquired sicknesses, Deaths as well. The review found.. Surprise, surprise Professionals do lie, cover up, make false denials still! serious concerns with the hospital’s error reporting policy. Many abuses, errors, deaths, bad incidents are still undeniably unreported. Ask me about it I saw too many. When a Montreal Verdun Hospital doctors, nurse often says to the patients as I have witnessed I cannot do anything to help you, go to your own doctor when you go home and tell him about it, that is not providing adequate medical aid. Just the tip of the iceberg.. and bad Hospitals, bad doctors, bad administrators like this one abound in Canada in reality.. unacceptable. Fire them all.. Public exposure and rightful prosecution of the bad, guilty persons serves everyone’s best interest, the bad persons included. Unacceptable still The adequate Treatment for Canada’s failing health system firstly is criminal prosecution and jail for the bad doctors, bad nurses, ALL ABUSERS for failing to help the sick people adequately and having enforced, Real management, supervision of doctors, nurses, medical and hospital workers.

    1. My comments are in respect of indian country. From your letter, I understand that it is an international problem and it is high time UNO should frame certain basic guidelines for the nations to adopt so that unnecessarily patients should not be put to unnecessary tests thus causing inconvenience. Medical transcription datas will vouch whether the treatment recommended and done is as per medical norms etc. can be seen later if compulsory keeping of medical records of patients are kept and given to patients for their use for verifying the authenticity of treatment done by discussion with another doctor so that there will be check on doctors and quality of treatment will increase geometrically in the universe. Ofcourse no two doctors can agree on same lines but unnecessary and unrelated treatments just to raise some additional income to hospitals can be controlled. Thanks for kindling my mind further.

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