A recent dispute between hospitals in North India and Bajaj Allianz General Insurance Company has been resolved, allowing hospitals to resume cashless services for policyholders. The Association of Healthcare Providers of India (AHPI), which represents over 15,000 hospitals, had temporarily halted cashless services due to a disagreement over reimbursement rates and tariffs. The hospitals claimed that the insurer’s reimbursement rates were too low, leading to financial stress, and that the insurer was using predatory pricing tactics.
The AHPI also alleged that the insurer was questioning the clinical decisions of treating doctors and pushing for the use of cheaper drugs and implants, which may not be in the best interest of the patient. The hospitals argued that medical inflation in India is around 7-8% per year, driven by rising prices of consumables, utilities, and other overheads, making it unsustainable to continue with the same reimbursement rates.
The insurer, Bajaj Allianz, has agreed to address the concerns of the hospitals and has committed to formal actions to resolve the issues. The company’s MD and CEO, Dr. Tapan Singhel, stated that the resolution of the dispute is in the interest of policyholders and citizens who should not face interruptions in their access to cashless healthcare.
The dispute highlights the ongoing issues between hospitals and insurers in India, with insurers arguing that non-transparent pricing and inconsistent treatment costs across hospitals require a central regulator to standardize charges. Some insurers have suggested onboard hospitals on the National Health Claims Exchange (NHCX), a digital health insurance claim platform developed by the Ministry of Health and Family, to bring transparency in pricing for consumers.
The resolution of the dispute is a positive development for policyholders and hospitals, ensuring that cashless services can continue uninterrupted. However, the underlying issues surrounding reimbursement rates and tariffs remain a concern, and it is likely that similar disputes will arise in the future. The use of platforms like NHCX may help to address some of these issues and bring greater transparency to the healthcare industry.