Will stop cashless facilities if grievances with insurance companies are not resolved: AHNA

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Representatives of the Ahmedabad Association of Hospitals and Nursing Homes (AHNA), at a press conference in Ahmedabad on Friday, said they would stop cashless facilities at their member hospitals and nursing homes after January 15, 2022 if the association’s grievances with public sector insurance companies are not resolved by then.

One of the main complaints of the AHNA, according to its president, Dr Bharat Gadhvi, is that the prices of the various procedures and hospitalizations have not been revised for the last five years, unlike the price revision carried out each year. by private insurance companies.

Specifically naming four public sector insurance companies – New India Assurance, Oriental Insurance, United India Insurance and National Insurance – with which AHNA members have faced problems, Dr Gadhvi added: “Medical care have evolved over the years, as has the quality of life. MRI and CT scans have become regular procedures and costs have increased. Insurance companies refuse to pay for used disposables, including disinfection fees or fees for gloves. Routine discharge takes 30 minutes, but patients insured by these companies take up to six hours or more or sometimes even a day’s delay. But these public sector insurance companies have not established or updated their infrastructure and until they do, such problems will persist. We suggest that patients refrain from using the services of these four companies if they want appropriate health services. “

Almost 100 to 125 hospitals and nursing homes in the AHNA are expected to stop cashless payments after January 15, 2022. A stop in cashless payment would mean that a patient will have to pay for medical services in the hospital and will have to pay. then claim the expenses incurred. at the hospital of the insurance company upon presentation of receipts for procedures or medical services.

Other grievances include a “delay of up to three to six months” in payments to hospitals with arbitrary deductions, which would otherwise have to be settled within 30 days according to the AHNA, as there is no no qualified physician in Third Party Administrators (TPA) to reasonably and fairly assess claims and no tripartite agreement between hospital, insurance company and TPA has been established. TPA is a licensed company / agency / organization from the
Insurance Regulatory Development Authority (IRDA) to handle complaints.

Dr Manish Bhatnagar, Chairman of AHNA Insurance Committee and Owner of Icon Hospital in Ahmedabad, said: “We don’t want to bother our patients, but doing business with these insurance companies is bad business. . We end up with consumer disputes and it is embarrassing for us to deal with this kind of inefficiency. There is no transparent process for deciding fees for hospitals. The last rate review was done in 2014, but hospitals received approval in 2016. Usually, public insurance companies review rates once every five years. We demand uniformity of rates and agreements instead of certain hospitals being given an ad hoc arbitrary advantage by insurance companies when they offer certain hospitals better rates. “

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