September 20, 2010

Sweet prescription for cashless mediclaim

Patients who are undergoing treatment and have cashless medical policies can now breathe easy. Their existing policies will cover their expenses even if the hospital they are admitted to is no longer a part of the preferred provider network (PPN) of their insurer.

In a recent order, the Insurance Regulatory and Development Authority (Irda) asked all life and general insurance companies to allow cashless facility to patients who are already being treated.

“Being denied the benefits of a policy you have paid for while your close one is going through a medical emergency is the last thing you are prepared for,” says Bangalore-based A Shridhar, who faced this situation when his wife was admitted to a hospital. Like Shridhar, many policyholders were caught off-guard when the four public sector general insurers — United India Insurance, New India Assurance, Oriental Insurance and National Insurance — removed 300 hospitals from their PPN list. Issues of over-pricing is the crux of the tussle that began a couple of months ago.

Present scenario
Many insurers say the issue is on the verge of being resolved after various rounds of discussions between them and the hospitals. Yet, only the smaller hospitals have joined hands with the insurers. Under the agreement, the two sides have fixed prices for 42 procedures. The public sector insurers are also working on a premium cashless policy, but nothing has been finalised.

Irda has also asked insurers to keep policyholders informed about changes in their PPN lists. The order states, “The insurers are directed to inform policyholders the nearest alternative hospitals where the cashless facility is available.”

Reaching out to policyholders
Obeying Irda’s order, public sector general insurers say they are making arrangements to provide better services to policyholders. Insurance companies discourage policyholders from availing of cashless treatment in non-network hospitals. However, according to G Srinivasan, chairman and managing director, United India Insurance, the company has anyway extended the cashless facility to policyholders who are in the middle of treatment. “We have been giving advertisements saying emergency or trauma treatments can continue on a cashless basis even in non-network hospitals,” he says.

This is the first time the company is re-jigging its PPN list, also updated on the website. According to Srinivasan, “At present, 450 hospitals are part of this list, and many more will join soon. Any policyholder can check the website to spot the nearest hospital.”

The number of hospitals varies from city to city. At present, there are 110 hospitals in the PPN in Mumbai. The public sector companies have also resorted to advertising in newspapers to reach out to a large number of policyholders. “Besides, we are still in talks with hospitals and the list is being updated on a daily basis,” says a senior official at New India Assurance.

Their private sector counterparts, though not part of the PPN row anymore, are reaching out to policyholders individually.

Hemant Kaul, CEO and managing director, Bajaj Allianz General Insurance, says, “Our PPN list has hardly seen any change. But whenever there is any, we inform each policyholder.”

Insurance companies’ customer care centres can also be contacted to know more about hospitals offering the cashless facility. Life insurance companies, too, have a small health insurance portfolio, ranging from one to five per cent. Though most of them have tie-ups with third-party administrators, they claim to keep each policyholder updated about any slightest change in their policies and hospital tie-ups through electronic mails and newsletters.

Link: Original Article

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