Cashless hospitalization issue resolved?

By BankBazaar.com | August 23, 2010

After negotiations, it has been decided that hospitals will be categorized in 3 categories based on the infrastructure capabilities and the rates will be standardized for 42 standard medical procedures covering almost all ailments requiring hospitalization for the 3 categories of hospitals. The rationale is that high-end or specialty hospitals cannot be asked to accept tariffs applicable to smaller ones.

Cashless hospitalization facility may soon be restored with the standoff between insurance companies and hospitals on the verge of a resolution. This spat came to the forefront in July when 18 insurance companies including the four public sector entities, dropped several hospitals from the list that allowed mediclaim policy holders cashless hospitalization on account of overbilling. While the final agreement is under way, it may still take close to a month for it to be released in its entirety. It seems that policy holders will have to shell out more to cover treatment at super specialty hospitals. So in Mumbai, if you want to be treated at Lilavati hospital or Breach Candy among others, you will have to pay a higher premium.

After negotiations, it has been decided that hospitals will be categorized in 3 categories based on the infrastructure capabilities and the rates will be standardized for 42 standard medical procedures covering almost all ailments requiring hospitalization for the 3 categories of hospitals. The rationale is that high-end or specialty hospitals cannot be asked to accept tariffs applicable to smaller ones.

The negotiation process with the various hospitals is underway and in Delhi it has been concluded been concluded with Gangaram and Medicity, Gurgaon, figuring among the list of high-end hospitals. Others such as Apollo and Fortis, which have presence in other metros, are also ready to come on board on the same rates that Gangaram and Medicity have agreed to. In Mumbai, because of high real estate prices, the packaged rates may not be accepted by some players.

The complete list will be available once these hospitals sign the deals with third-party administrators (TPAs). Once this new structure comes into play, it is likely to result in savings for insurance companies who were bleeding because of hefty rates charged by hospitals. On the other hand, customers wanting treatment in high end/super specialty hospitals should be ready to pay more as premium.

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