Covid patients losing cashless benefits due to insurance companies, say hospitals

Nagpur: Many Covid-19 patients had to spend hours more in hospital, even after getting discharge, just because their cashless claims were not settled by insurance companies. Many had to pay substantial amount to the hospital after the insurance company rejected a major part of the claim citing various technical reasons. Though patients blame treating hospitals in such cases, city hospitals released a statement on Sunday blaming insurance companies for this mess.

Vidarbha Hospitals Association (VHA) has written to divisional commissioner Sanjeev Kumar that insurance companies are creating unnecessary hurdles in releasing cashless benefits for Covid patients.

“Health insurance companies are trying to extract their pound of flesh by arbitrarily decreeing that patient should have been treated in general ward or at home on OPD basis. This creates unwanted acrimony with relatives at time of discharge,” reads the statement by VHA president Dr Ashok Arbat, secretary Dr Alok Umre and convener Dr Anup Marar.

Hospitals have claimed that they had started cashless benefits after an assurance by divisional commissioner in a confidence building meeting held during peak of Covid-19. So, they have complained to the divisional commissioner and requested him to direct insurance companies in this regard. “Private hospitals are already charging patients capped prices as per government directives. Even this less amount on credit basis is causing financial strain on us. Additionally, the fleecing by health insurance companies is adding salt on our wounds,” said Dr Anup Marar.

“Ethical discretion of placing incoming Covid patients at home or in general bed or in the ICU lies with the doctors only. Hence, neither hospital administration nor health insurance companies have the right to opine on placement of patients and their treatment,” said Dr Umre. Dr Ashok Arbat said, “Private hospitals had initially avoided provision of cashless benefit to avoid just such unwanted confrontation related to billing at the time of discharge. In a meeting with divisional commissioner, we were told insurance companies will provide immediate sanction and will clear bills on priority. Respecting his words, we commenced admission of health insurance patients with provision of cashless benefit.”

While the divisional commissioner’s office is yet to reply, a senior official from a leading health insurance company said the companies have their own mechanism of settling claims and they cannot be directed to settle claims bypassing their process. “All companies and TPAs follow IRDA rulings. Covid-19 claims are complicated as compared to non-Covid illnesses. Hence, patients need to pay some amount,” he said.

Docs: Make uniform format for NMC Covid queries

During the pandemic time, private hospitals are facing various queries by NMC officials who visit them often regarding billing enquiries. Hospitals have now written to the municipal commissioner and requested a uniform format of billing related enquiries. According to doctors they are being punished for serving people. “The regular visits of NMC officials seeking details are like persistent hammering. These officials keep changing stance on queries related to bills of Covid patients. This is taking a toll and affecting day to day working in private hospitals,” reads the letter signed by VHA officials.

“A uniform policy and clarity on format of queries must be communicated to all NMC officials deputed to various Covid hospitals. This homogeneity will go a long way in streamlining process of information collection,” the statement concludes.

Source: The Times of India