Insurers: No deposit for cashless scheme

Kolkata: Leading health insurers have made it clear that hospitals in their network should not ask for pre-admission deposit amounts from patients with cashless health insurance policies.

The clarification came on Monday, two days after the West Bengal Clinical Establishment Regulatory Commission (WBCERC) allowed hospitals to charge an advance of Rs 50,000 or 20% of the estimated treatment cost (whichever was lower) at the time of admission. The regulatory panel’s move followed repeated complaints from patients — both Covid and non-Covid — against hospitals demanding hefty deposit amounts during admission.

The panel’s order, however, brought to the fore sharp differences of opinion regarding patients having cashless insurance policies. WBCERC chairperson Justice Ashim Kumar Banerjee said on Monday that patients under cashless insurance facility could not be asked to pay any deposit. The insurance majors’ clarification now implies unanimity among three stakeholders — patients, insurance firms and the regulatory panel — on this vexed issue.

Private-sector hospitals have said they have been constrained to ask for deposit amounts to “ensure a dispute- and hassle-free bill-clearing process” when patients are released. Some of them said on Monday that they would stick to the commission’s direction and not insist on any advance payment but some others said they were still discussing the issue and would take a final call on Tuesday.

Insurance companies, however, have made their stand clear. National Insurance general manager (health) Sophia Singh told TOI that the Insurance Regulatory and Development Authority had clarified a week ago that the cashless facility could not be denied to patients covered by such policies. “Cashless means no advance for treatment. Hospitals should not ask for advances and they are supposed to provide cashless facility. We shall issue some more advisories to third-party administrators,” she added.

Oriental Insurance regional manager and health vertical head R R Mohanty said IRDA rules mandated that the cashless facility could not be denied to relevant patients. “A valid cashless patient should not be asked for any advance,” he added. Four public-sector general insurers — National Insurance, New India Assurance, Oriental Insurance and United India — together control over 75% of the health insurance market in Bengal.

Hospitals, however, were groping for a consensus on Monday. Peerless Hospital said the issue “remained unclear” but it would stick to its existing policy of not insisting on deposits. “Cashless patients need an approval from insurance companies, which rarely comes through in case of Covid patients who are admitted in a hurry. But we have not been asking for advances and instead seek undertakings stating that patients are covered by insurance. We will continue with this,” Peerless Hospital CEO Sudipto Mitra said.

Another private hospital CEO felt the insurance clarification had made things more confusing. “The WBCERC has allowed us to charge an advance but insurance companies are barring it for cashless patients. We wish we could avoid this confusion during the pandemic,” he said. Oriental Insurance’s Mohanty said it would ask third-party administrators to probe complaints or may appoint an independent agency to investigate the matter. “We can de-empanel hospitals for some time if allegations are found to be true,” he added.

Hospitals, however, are not under the IRDA. “Absence of a hospital regulatory authority is a problem,” National Insurance’s Singh said.