Standardise medical treatments to check over-billing by hospitals, says IRDA chief
Sonal Matharu | July 30, 2010
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.
Imprints of the Populist Time By Ranabir Samaddar Orient BlackSwan, 352 pages, Rs. 1105 The crisis of liberal democracy in the neoliberal world—marked by massive l
Union minister of finance and corporate affairs Nirmala Sitharaman presented the Union Budget 2023-24 in Parliament on Wednesday. The highlights of the Budget are as follows: PART A Per capita income has more than doubled to Rs 1.97 lakh in around
Union Budget 2023-24, presented by finance minister Nirmala Sitharaman in the Parliament on Wednesday, outlined the vision of Amrit Kaal which shall reflect an empowered and inclusive economy. “We envision a prosperous and inclusive India, in which the fruits of development reach all regions an
Former World Health Organisation (WHO) chief scientist Soumya Swaminathan takes charge as chairperson of M S Swaminathan Research Foundation (MSSRF) from February 1. Founded by her father, the legendary agricultural scientist M S Swaminathan, MSSRF was set up to accelerate the use of m
The digital revolution is being led by India. Digital governance is a key component of the government's ambition to transform India into a society where everyone has access to the internet. It includes both M-governance and E-governance, which are major methods for the delivery of services via mobile devic
Saundarya Lahari: Wave of Beauty Translated from the Sanskrit by Mani Rao HarperCollins, 218 pages, Rs 399 ‘Saundarya Lahari’, usually ascribed to Adi Shankaracharya, has a unique status among the religious-spiritual works of Hinduism.