Starting from September 1, approximately 15,000 hospitals in India will stop providing cashless treatment to policyholders of certain insurance companies. The Association of Healthcare Providers (India) (AHPI) has taken this decision, which will affect insurance companies such as Bajaj Allianz and Care Health Insurance.
The reason behind this move is a dispute over pending claims and low reimbursement rates. According to reports, hospitals have been facing significant delays and shortfalls in payments from these insurance companies, resulting in substantial losses for the healthcare providers. As a result, the hospitals have decided to suspend cashless services for policyholders of these companies.
The insurance companies, however, have termed the decision as “unilateral” and have expressed their disappointment over the move. They claim that the hospitals’ decision will affect thousands of policyholders who will no longer be able to avail cashless treatment at these hospitals.
The AHPI had initially planned to approach the Competition Commission of India (CCI) and the Insurance Regulatory and Development Authority of India (IRDAI) over the issue, but has now decided to defer the plan. The association has instead asked the insurance companies to withdraw their advisories and work towards finding a resolution to the pending claims issue.
The larger picture behind this dispute is the long-standing issue of low reimbursement rates and delayed payments from insurance companies to hospitals. This has resulted in a significant buildup of pending claims, putting a strain on the finances of healthcare providers. The hospitals claim that they are being forced to bear the losses, while the insurance companies are making profits.
The situation is likely to affect thousands of policyholders who will have to bear the brunt of the dispute. The policyholders will either have to pay out of pocket for their treatment or look for alternative healthcare providers that still offer cashless services. The dispute highlights the need for a more efficient and transparent claims settlement process to avoid such situations in the future.