There seems to be no end to the suffering of individual health-insurance policy-holders, stuck in a row between the public health insurance companies and select hospitals, as the insurance regulator Insurance Regulatory and Development Authority (IRDA) refuses to intervene.

At a conference organised by the Federation of Indian Chambers of Commerce and Industry (FICCI) here on Friday on health insurance, IRDA chairman J Hari Narayan said that the issue of cashless mediclaim policy, where the public health insurance companies have refused to pay claims by select private hospitals for their inflated medical bills, is not a regulatory affair. He added that the hospitals involved will settle the dispute with the insurance companies soon.

“The cashless mediclaim policy is a personal conflict between the hospitals and the insurance companies. It is not a regulatory issue. However, if the health insurance contract is violated, then IRDA can intervene and hold the companies liable.”

He, however said that complaints can be filed with the insurance company and the IRDA against contract violations. The company found violating the contract, will be fined upto rs 5 lakh by IRDA.

However, over the cashless mediclaim facility Narayan refused to admit that the insurance companies intimated their customers almost after two weeks after striking hospitals’ name from their cashless service providers list, hence, violating the contract.

On 1st July, four public sector health insurance companies - New India Assurance, United India Insurance, National Insurance and Oriental Insurance – had stopped the cashless service alleging over-billing by some private hospitals.

Narayan said that the stakeholders involved in the issue are meeting today to resolve the dispute. He added that on 1st July when this dispute started, 328 hospitals in four cities – Delhi, Mumbai, Chennai and Bangaluru – were offering cashless facility. And on 30 July, this number stands at 391. “So the number of hospitals promising cashless treatment has actually increased,” he said.

Talking about standardising the health delivery services, he said that all hospitals must follow universal guidelines and the transactions should be made transparent. He said, “For medical procedures, doctors, Medical Council of India or the health ministry should prescribe standards rather than the health insurance companies. Also, hospitals should have a standardized system of charging patients for treatment. The treatment cost for those coming with an insurance cover should not be more than for those who come without it.”

FICCI health services chairman Anjan Bose later added that the FICCI’s team has formed guidelines for 21 medical treatments and that list has been sent to the health ministry for their approval. Once approved, all hospitals will have to follow those guidelines for treating patients for the respective illnesses and this will keep a check on unnecessary treatment procedures.

“Standards for 11 critical illnesses are under the review of the IRDA. Once that is complete, we will forward that to the health ministry as well. Besides this, all hospitals have different billing formats and discharge certificates which are very complex. A standardised form for these procedures will bring in transparency in the way hospitals operate” said Bose.