{"id":37814,"date":"2010-07-24T11:57:54","date_gmt":"2010-07-24T11:57:54","guid":{"rendered":"http:\/\/beta.tehelka.com\/?p=37814"},"modified":"2010-07-24T11:57:54","modified_gmt":"2010-07-24T11:57:54","slug":"four-state-owned-insurance-firms-have-blacklisted-150-hospitals-for-inflating-bills-now-what","status":"publish","type":"post","link":"https:\/\/tehelka.com\/four-state-owned-insurance-firms-have-blacklisted-150-hospitals-for-inflating-bills-now-what\/","title":{"rendered":"Four state-owned insurance firms have blacklisted 150 hospitals for inflating bills. Now what?"},"content":{"rendered":"

\"Cut<\/a>
Cut to size Hospitals across the country are known to indulge in fraudulent billing. Now they are paying for it<\/figcaption><\/figure>
\nHOSPITALS<\/strong> across Delhi, Mumbai, Chennai and Bengaluru have been struck off the list of facilities for cashless insurance \u2014 a move that will ultimately benefit policyholders. The companies \u2014 United India, Oriental Insurance, National Insurance and New India Assurance \u2014 are expected to blacklist more hospitals that, in collusion with third party administrators (TPAs), have been grossly inflating bills
\nPublic sector general insurance providers account for close to 70 percent of the health insurance market, and between April and September 2009 they had together collected close to Rs 2,300 crore as health insurance premium. The insurers say they are more than willing to extend their Preferred Provider Network (PPN) \u2014 the number of hospitals that provide cashless transaction facility under the medical insurance policy. But the offer comes with a healthy rider: there must be transparency in the billing process
\nInsurance companies and leading healthcare providers, including Fortis Hospitals, Max Healthcare and Apollo hospitals, discussed the issue in Mumbai on July 13. The three, which are members of the National Committee on Healthcare of the Confederation of Indian Industries (CII), are among the hospitals removed from the PPN list on July 1.
\n\u201cThe hospital industry wants more hospitals to be included in the (PPN) list and we are open to it,\u201d New India Assurance general manager S Gopalakrishnan told TEHELKA. \u201cBut we want more people included in the cashless facility category. The benefit should reach everyone and overcharging must end. If a hospital is found engaging in fraudulent practices, it will be struck off the list. If they comply, total transparency can come about in a year.\u201d
\n
\"\"<\/a>
Dr Naresh Trehan
Chairman And Managing Director, Medanta Medicity<\/figcaption><\/figure>
\nThe insurers\u2019 message appears to have gone home, with the hospitals finally \u201cshowing keenness\u201d to address the malaise. Even so, the gap between word and deed remains wide, and so far there is little on the ground to suggest they are as sincere as they are trying to sound. \u201cWe have kept our options open. These include reducing fees and various other charges, making billing transparent and helping insurance companies ward off losses,\u201d says Max Healthcare Chief Executive Officer and Managing Director Pervez Ahmed. In the same breath, however, Ahmed claims he is \u201cstartled\u201d by the sudden rap on their knuckles. \u201cThe unilateral decision is surprising. They held no negotiations on the issue. Individual customers are sure to find themselves in a soup.\u201d
\nBut the insurance companies say they stand by their July 1 decision, claiming that some hospitals charged higher fees from insured patients as compared to those without insurance. This was done through fraudulent billing, they claim \u2014 an allegation that gets progressively harder to counter.
\nIndeed, even Dr Naresh Trehan, chairman and managing director of Medanta Medicity, a Gurgaon-based specialty healthcare provider, says he does not rule out the incidence of fraudulent billing \u201cin some cases\u201d. \u201cBut it isn\u2019t widespread,\u201d he insists, adding, \u201cWhat\u2019s more, insurance companies have failed to establish that bills have indeed been manipulated.\u201d
\nThe insurers will have none of that, and insist they have a strong case. Counters G Srinivasan, chairman and managing director of United India Insurance: \u201cOur claim payment ratio stands at 120 to 125 percent. In many cases we found the bills exorbitantly high and we had no option but to delist these hospitals from the PPN.\u201d Even so, Srinivasan\u0192 says he understands the kind of problems that are likely to result from the blacklisting. \u201cWe will provide cashless transaction even in these hospitals in cases of emergency, and will also add more hospitals under the cashless transaction facility,\u201d he assures.
\nAccording to data provided by the watchdog body, the Insurance Regulatory Development Authority (IRDA), the total claim ratio in the case of health insurance during 2008-09 stood at 105.95 percent as against 107 percent a year ago. This means that for every Rs 100 of premium collected, insurance companies paid out Rs 106.
\nSignificantly, the claim ratio in the case of public sector insurers stood at 116.60 percent during 2008-09, as against 85.33 percent for private sector health insurance providers. And only the latter showed improvement in their claim ratios. The losers for the most part were the state-owned companies.
\nBut neither IRDA, nor the General Insurance Council, the apex body of general insurers, is willing to intervene or mediate. While IRDA says the matter is outside its purview, Council secretarygeneral SL Mohan asks, \u201cHow can we step in till they approach us?\u201d
\nTHE HOSPITALS meanwhile keep parroting the old line \u2014 though every time they do so one detects an underpinning of caution. For, in the same breath that people like Ahmed of Max and Medicity\u2019s Dr Trehan claim the move will only hurt the patients, they slip in the fact that they are not sitting by idly.
\nSays Dr Trehan: \u201cTo avoid that (fraudulent billing) we are ready to bring in more checks and balances, provided they (the insurance companies) also take some corrective steps.\u201d He also wants frequent interaction between hospitals and insurers \u201cto arrive at a mutually beneficial decision, which in turn would benefit policyholders\u201d.
\nAsked why some hospitals charged higher fees, Dr Trehan sought refuge in an analogy, comparing roadside food with what is available in upscale establishments. \u201cYou may get equally tasty food at a dhaba as in a five-star hotel. But five-stars charge more, because they maintain hygiene. The same applies to hospitals. High-end hospitals focus a lot on cleanliness and take several precautions. It is therefore natural that their charges will be on the higher side.\u201d
\nBut it is not just government companies that are excluding hospitals from their preferred list. Bharti AXA, the private sector general insurance provider, too has trimmed its list of approved hospitals. \u201cWe found that some hospitals were fudging bills and so we removed these from our list. We have scaled down the number of hospitals we have a tie-up with to 3,800, down by 200. None of the big names have been excluded though,\u201d says Bharti AXA Chief Executive Officer Amarnath Ananthanarayanan.
\nThe only question nobody is asking is, should not the erring hospitals \u2014 big or small \u2014 be fined?
\n[box]
\nHOSPITALS VERSUS INSURERS<\/strong>
\n>STRUCK OFF<\/strong>\u00a0<\/strong>
\n150 hospitals were removed from state-run insurers\u2019 Preferred Partner Network (PPN) list starting July 1
\n>\u00a0MARKET SHARE<\/strong>
\nGovernment-owned companies account for 70 percent of the health insurance market
\n>\u00a0<\/strong>CLAIM RATIO<\/strong>\u00a0<\/strong>
\nFor government companies, it stands at 116 percent
\n>\u00a0GENERAL COMPLAINT<\/strong>
\nBharti AXA General too reduces the number of affiliated hospitals
\n[\/box]<\/p>\n","protected":false},"excerpt":{"rendered":"

“If a hospital is found engaging in fraudulent practices, it will be struck off the list. If they comply, total transparency can come about in a year\u201d, New India Assurance general manager S Gopalakrishnan told TEHELKA.<\/p>\n","protected":false},"author":71,"featured_media":37833,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":[],"categories":[56],"tags":[6662,3957,6663,3954,6138],"_links":{"self":[{"href":"https:\/\/tehelka.com\/rest-api\/wp\/v2\/posts\/37814"}],"collection":[{"href":"https:\/\/tehelka.com\/rest-api\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/tehelka.com\/rest-api\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/tehelka.com\/rest-api\/wp\/v2\/users\/71"}],"replies":[{"embeddable":true,"href":"https:\/\/tehelka.com\/rest-api\/wp\/v2\/comments?post=37814"}],"version-history":[{"count":0,"href":"https:\/\/tehelka.com\/rest-api\/wp\/v2\/posts\/37814\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/tehelka.com\/rest-api\/"}],"wp:attachment":[{"href":"https:\/\/tehelka.com\/rest-api\/wp\/v2\/media?parent=37814"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/tehelka.com\/rest-api\/wp\/v2\/categories?post=37814"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/tehelka.com\/rest-api\/wp\/v2\/tags?post=37814"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}