Doctor- Patient interaction has evolved from a simple conversation to a complex industrial dialogue in last few decades. With patients being defined as consumers and legalities coming in, has converted the simple treatment into a commercial and legal issue. Many agencies have positioned themselves between doctor and patient to mediate the deal and to have benefit from both sides. But the flip side of the arrangement is that all agencies want a significant pound of flesh for themselves.  Survival of Insurance industry is dependent upon expensive medical costs.   If costs are low, there would be no need for insurance. The involvement of Investors, insurance companies, suppliers, mediators TPA’s  to facilitate the complex interaction makes health costs skyrocket.

         With every agency trying to extract more and more, the core stake holders- doctors and patients are being alienated. Such complexities have a potential to affect the medical services in an adverse manner. The clash for more profits is inevitable.  Being consumers may be a loss making deal for the patients.

40 Nagpur hospitals Stop cashless health insurance facility

40 City Hospitals join hands
Beneficiaries of National Insurance, United India Insurance & Oriental Insurance to get affected from 1ST Dec

Nagpur: The ongoing tussle between the cartel of 3 health insurance companies namely National Insurance Company Ltd, United India Insurance Company Ltd, Oriental Insurance Company and their 6 TPAs i.e. MD India Health Insurance TPA (P) Ltd, Genins India Insurance TPA Ltd, Family Health Plan TPA Ltd, Paramount Health Services & Insurance TPA Pvt.Ltd, Health Insurance TPA of India Ltd and Health India TPA Services Pvt Ltd with member hospitals of Vidarbha Hospitals Association continues to grow serious with more and more hospitals joining hands with affected VHA members. The hospitals are aggrieved because of package rates being decreed by this group of companies which is presently 50-80% less than ongoing agreed open billing rate list. The hospitals are being threatened by the cartel to either agree to deliver services in these subsidized rates or face removal from approved list of hospitals. Insurance Beneficiaries Association and Vidarbha Private Hospital Employees Union have also thrown their weight behind VHA with their own justifications.

Beneficiaries are facing heat on account of the threat of health insurance cashless facility withdrawal presently announced by all major quality conscious hospitals of Nagpur including Wockhardt, Orange City, KRIMS, Alexis, Meditrina, Care, Viveka, Suretech, Arogyam, Center Point, Midas, Ortho Relief, Hope, Icon, Lotus, Samarpan, Sengupta, Treat Me, Radiance, Keshav, Swasthyam, Crescent, Sushrut, Aureus, Shravan, Grace Orthocare, Abhinav, SS.Multispeciality, Metro City, Medicare, Getwell, East End, Safal, New Era, Arihant & Shrikrishna, Criticare, RNH, Asian Kidney, Asha and Platina.

Ganesh Iyer- General Secretary of Insurance Beneficiaries Association stated that even if hospitals agree to attend patients in such minimalistic package costs which is inclusive of medicines, consumables and diagnostics; it will surely affect quality of treatment and complications may increase. Hospitals till date were issuing prescriptions to patients and they used to get the medicines on cashless basis from hospital pharmacy so the relatives were aware of what was being procured and given. If package rates are levied, they will be unaware and hospitals because of such low rates will use substandard drugs, he alleged. Moreover, when health insurance premiums are increasing day by day, why fair rates are not being offered to hospitals based on certain valuation criteria? he queried. He has advised all the beneficiaries of these cartel to get themselves ported to other insurance providers.

Prakash Shende-Working President of Vidarbha Private Hospitals Employees Union has stated that if hospitals agree for such low rates, they will be forced to either reduce remuneration or retrench personnel which will be detrimental to their members.

Citizens were eagerly waiting for an agreeable resolution to this ongoing struggle. All concur that till amicable resolution is found, both parties should have agreed to continue services in old agreed rates. VHA had conveyed its readiness to do so in larger interest of society and mediate in this matter. However, looking into the adamant stand of cartel, VHA today conveyed these insurance companies about their inclination to stop cashless facility to their beneficiaries w.e.f.01/12/2021.

Deploring the cartelization of the health insurance companies; Dr. Ashok Arbat- VHA President said that soon all their 160 member hospitals will be forced to join this agitation if these companies do not mend their ways and value quality care by offering reasonable rates.

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