Insured coronavirus patients get a raw deal

Coronavirus patients in some parts of India have discovered to their chagrin that the cashless claim facility offered by their insurers may not be honoured by hospitals, adding to their distress at a time of crisis.

Family members have had to frantically arrange large sums of cash at short notice as critical patients waited to be treated because hospitals wouldn’t accept cashless settlement of hospital bills by the insurance provider.

Ahmedabad-based Parthiv Hitendrabhai Salot and his father contracted covid-19, the respiratory disease caused by the coronavirus. “My father required immediate hospitalization because his lungs were affected," Salot said in an interview, recounting their troubles after they tested positive on 8 June. “All private hospitals I reached out to said they will not entertain cashless claims for covid-19 patients. I had to arrange for money by borrowing from my relatives and friends overnight. I was asked to deposit ₹1 lakh at the time of admission," said Salot, 31, a chartered accountant.

Salot soon discovered that if hospitals refuse cashless facility, there isn’t much that the insurance company can do. On paper, insurance companies do have a network of hospitals that accept cashless admissions, but they have little control if the hospitals decide to stop the facility. For two days, Salot looked for private hospitals that would accept cashless claims without success.

Surat-based Tejas Jariwala, 34, faced a similar unpleasant situation when two family members tested positive for the virus. “All 12 private hospitals we called for admission said they don’t have a provision for cashless claims," said Jariwala, research head at a stock markets consultant. Considering the situation, the family decided to check with the public health authorities and managed to get the patients admitted to a government hospital.

Private hospitals claim their hands are tied. Dr Bharat Gadhavi, president of Ahmedabad Hospitals and Nursing Homes Association (AHNA), said, “In many cases the insurers have not revised cashless agreement rates in the last four years, and given medical inflation, the old rates are untenable. Also, hospitals are cash-strapped and this further gets worsened by the fact that insurers don’t settle the claims on time," said Gadhavi. Gadhavi said his association has come up with standard rates and if they are acceptable to insurance companies, hospitals would be very happy to process cashless treatment.

On 3 July, similar incidents were brought to light by Kirit Somaiya, a Bharatiya Janata Party Leader (BJP), on Twitter. Somaiya brought to the regulator’s notice that a few private hospitals in Mumbai were not providing cashless claims facility. “Hospital authorities insist the patient should first make payment to the hospital on completion of treatment and, thereafter, the hospital authority will pay them back after getting insurance money from the insurance firm," said Somaiya in his letter to the insurance regulator.

Dr. Sujit Chatterjee, chief executive of Dr LH Hiranandani Hospital and president of Mumbai Healthcare Providers Association, said he hasn’t heard of hospitals denying cashless claims. “We haven’t come across any instance of hospitals denying eligible cashless claims. But if cashless claims are being denied, one of the possible reasons could be that the insurance firm and the hospital are not in agreement over the rates for covid," he said.

Dr Girdhar Gyani, director general, Association of Healthcare Providers (India), said cashless claim denials may be few and far between. “For instance, Delhi, Haryana and Karnataka have prescribed covid treatment rates and this is what we take from uninsured patients. However, in case of insured patients, rates are as per agreements and so maybe if insurers insist on government rates, it could lead to a denial of cashless claim," he added.

Insurers said the denials is not widespread. “If the hospital is saying no to cashless claims, it’s not the insurer’s decision. In many cases, we wouldn’t even know," said Bhabatosh Mishra, director – underwriting, products and claims, Max Bupa Health Insurance Co. Ltd.

Source: Live Mint

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