A recent standoff between hospitals and health insurance providers in India has raised concerns among policy-holders about the availability of cashless health insurance services. The Association of Healthcare Providers of India (AHPI) had advised its member hospitals to suspend cashless services provided by Bajaj Allianz, citing issues such as abrupt stoppage of services, delays in empanelment, payment disputes, and questioning of clinical decisions. The General Insurance Council (GIC) responded by calling out AHPI’s “sudden unilateral action” as creating confusion among policy-holders and denting trust in the health insurance ecosystem.
The hospitals’ concerns center around the cashless authorization process, where items like implants are left open, and costs are disputed at payment time. They also claim that insurance companies have not revised treatment rates for years, despite medical inflation, and use collective bargaining to pressurize hospitals to comply. On the other hand, health insurance companies are unhappy with hospitals over higher charges and unreasonable treatments, and are calling for a strong healthcare regulator to standardize treatment protocols and rates across hospitals.
The GIC points to initiatives like “cashless everywhere” as efforts to ensure patients get treated without financial stress, but admits that there is no apex body for them to lodge complaints of higher charges or unreasonable treatments by hospitals. Insurers say that standardization of rates across treatments at hospitals under all insurance companies could eliminate overcharging and bring down medical inflation, which is currently pegged at 12-14 percent.
The standoff has left policy-holders worried about making hefty upfront payments to admit a patient, despite having paid high health insurance premiums. While hospitals will still treat patients and insurance companies will still reimburse payments, patients will have to bear the brunt of making the initial out-of-pocket payment. The issue is not limited to Bajaj Allianz, as AHPI has raised similar issues with Care Health Insurance, and there are concerns that it could escalate to more hospitals not accepting cashless insurance.
Internal discussions are underway for a possible meeting between AHPI and GIC to resolve the outstanding issues, with the expectation of finding a workable mechanism to address the concerns of both parties. Health insurers expect hospitals to agree to come under common empanelment to provide cashless treatment to patients. The patient trust in hospitals and healthcare insurance has suffered, and it remains to be seen how the issue will be resolved to ensure that policy-holders can access cashless health insurance services without hassle.