There is something to rejoice from among the policy holders who usually complain with regard to the practice of some insurance companies which violates the cashless practice in view of medical situations. The Chairman of the insurance regulator Insurance Regulatory and Development Authority (IRDA), Mr J. Hari Narayan, said in view of this scenario that action will be taken against insurance companies violating the terms of cashless health insurance policy for consumers.
It has therefore been cleared by the beloved and smart chairman that “if there is a violation of contract entered into between the policy-holder and an insurance company, certainly the primary function of the IRDA is to uphold the contract, particularly in favour of the policy-holder,” Mr Narayan told reporters on the sidelines of a FICCI conference. Well, obviously this is something that each and every insurers should take into consideration very seriously if they do not want to be penalized.
In connection to this, the said IRDA chairman said that “an insurance company can be fined up to Rs 5 lakh for such wrongdoings. The aggrieved consumers can seek relief by calling the IRDA on a toll-free number 155255, he said, adding that orders have been given to insurance companies to regularly send to policy-holders the latest list of partner hospitals with cashless facility.” This move will surely benefit the insurance holders themselves.
It must be noted that in view of this set up there is indeed a great need for these insurance companies and the hospitals to agree some things that will benefit all the concerned parties. However, he maintained that there is no need to look into the issue from a regulatory point of view, and hoped that insurance companies and partner hospitals will sort it out among themselves.
CASHLESS FACILITY TO BE RESTORED: This reality has been discussed lately by a lot of concerned people primarily from among those in IRDA, the insurance companies and the hospitals concerned. Later, the issue was discussed at a CII-initiated discussion between private hospitals Fortis Healthcare, Apollo Hospitals, Max Healthcare Institute and Medicity, representatives of insurance companies United India Insurance, Oriental Insurance, National Insurance and New India Assurance and Raksha TPA, the third party administrator. There is therefore a great hope that things will be settles soon with this events going on.
What happened therefore in view of this talk between the different parties? After the meeting, Medicity Chairman, Dr Naresh Trehan, said that both sides will resolve their differences and restore cashless treatment under Mediclaim policies within 10 days. From July 1, the PSU insurance companies had removed around 150 hospitals from its list of Preferred Provider Network (PPN) that provides cashless treatment to policy holders. There are around eight crore Mediclaim policy holders in the country. Thanks then to the people particularly from IRDA who made this good move of gathering together all the concerned institutions in restoring the cashless policy.
Hence, he issue concerns instances of over-billing by hospitals for cashless facility, much higher than the facility where cash is paid in advance and reimbursed by the insurance company. This meant higher claims for cashless facility and subsequent losses to insurance firms. Insurance firms have also said that lower treatment cost will also reduce loading on policy premium at the time of policy renewal. This is something great indeed!
One thing that has been emphasized by the concerned insurance companies was: that the hospital rates be the same for cashless and reimbursement facilities. “There is a need to bring alignment and a balance between best price and quality healthcare,” Mr Trehan said, adding that there could be standardisation of the billing process in different hospitals.
Moreover, Mr Narayan also referred to a Parliamentary Committee report calling for the Government to consider setting up a regulator in the medical field. He said that either the Health Ministry or a medical regulator comprising experts should prescribe the standard procedures to be followed by the medical sector.
Separately, in a written reply to a question, the Minister of State for Finance, Mr Namo Narain Meena, said the insurers have confirmed that in case of emergency and trauma cases, cashless facility will be provided at all hospitals irrespective of whether they are part of the PPN or not.
Best Reading:
- Life Insurance Quotes in New Delhi : Max Life Insurance
- Top 10 Life Insurance Companies In The Whole Of India
- The Indemnity Principle of General Insurance
- How to Select the Right Health Insurance Policy
- Detecting Flaws in Business Insurance
In conclusion, this move of gathering together the various insurance companies together with the owners and Board of Trustees of the various hospitals will finally rest the minds of the worried policy and plan holders who may shell out extra cash from their pockets once the cashless policy between the patients and the hospitals will not be realized soon. But with the intervention of IRDA, hopefully things may finally become normal and once again settled. This move of IRDA is obviously something commendable by every policy owners knowing the fact that it is indeed not a joke to get hospitalized with all its bills concerned and involved.
{ 1 comment… read it below or add one }
In today's time we can not even rely on the well reputed companies like “Oriental Insurance” etc.
Me and all my family members have there mediclaim policies since 10 year and above, but till date I am not at all satisfied with any of there services because of their Incompetent agents and service providers.
I had already faced a big problem in the past with this company when we waited extremely long for the repayment of hospital bills & the refund of the left over policy amount of my dad's policy after he passed away in 2006,we ran every where but no one paid any attention to our problem, then we requested consumer court to file our case against the company etc. it took lot of time more then 1.5 years for solving the problem with the help of top company officers, who were very understanding and really helpful to us, I am still thankful to all who understood us and helped us.
Today I felt forced to write this mail coz of Mr. A.K CHOUDHARY's continues Irresponsible behavior and also filed a case in consumer court http://www.consumercourt.in/medical-insurance/1… , from last many year (almost 3-4 years) every time he came for the renewal of the policy, always took our photos for the cashless cards etc but always misplace it and never send the cashless card ever on time, sometimes cards comes after 5-6 months but along with the time the delay time was not reduced rather was becoming worse, all the times we submitted the photos twice or even thrice but this time from last almost 8-9 months we haven’t received our cashless card as yet, even they delay in sending the complete policy papers many times.
We as an old and loyal customers never said anything from so long time but now this is the height of irresponsibility on company's part.
Now i am no more interested to continue my policy, rather this time I’ll close it down with this company once and for all.
Regards,
Pranjal