Before we digest the process of “medical insurer’s cashless facility” we must first of all, explore its meaning. What is cashless facility? Cashless facility is service provided by an insurer wherein patient not required settling the hospitalization expenses at the time of discharge from hospital. The settlement is done directly by the insurance company. Cashless claims can be of two ways types. Planned where the insured is aware of the hospitalization 2-3 days in advance and emergency where the insured or any covered family members meets with sudden accident from bout of illness that requires immediate hospitalization.
Following are the situations under which one may be denied cashless hospitalization. First-If there is any doubt in the coverage of treatment of present ailment under the policy. Second- If the information sent to third party administrators is insufficient to confirm coverage and Third- If the ailment/condition is not being covered under the policy.
Following are the situations under which one may be denied cashless hospitalization. First-If there is any doubt in the coverage of treatment of present ailment under the policy. Second- If the information sent to third party administrators is insufficient to confirm coverage and Third- If the ailment/condition is not being covered under the policy.
Why stop cashless facility
According to an official of the insurance company due to the hospitals make false claims and they charges higher amount from the insurance companies four of the major state run insurance companies namely United India, New India, Oriental Insurance and National Insurance have decided to stop cash less hospitalization facility at some 150 odd hospitals across the country with effect from 1 July-2010.
Though reason given is that hospitals make false claims but re-imbursement of bills would continue as if the problem of false claims and inflated bills will solve. The insurance company should try to catch the culprit hospitals and doctors with inflated bills rather than deny patients the facility. Experts said rather than such a retrograde step, insurance firms must sit with hospitals and professionals to standardize treatment, improving billing format to induce transparency in the system and build trust among stakeholders. The inability to remove bad apples does not mean that insurance company should throw away the basket.
Though reason given is that hospitals make false claims but re-imbursement of bills would continue as if the problem of false claims and inflated bills will solve. The insurance company should try to catch the culprit hospitals and doctors with inflated bills rather than deny patients the facility. Experts said rather than such a retrograde step, insurance firms must sit with hospitals and professionals to standardize treatment, improving billing format to induce transparency in the system and build trust among stakeholders. The inability to remove bad apples does not mean that insurance company should throw away the basket.
Regulatory Stand Needed
The Insurance Regulatory and Development Authority (IRDA) chairman Hari Narayan said on 11 July that it had decided to scrutinize the matter of insurance companies stopping the cashless capability for hospitalization of patients to mediclaim policy holders. IRDA need to quickly implement provisions in the new cashless health reform law and stimulus legislation that focus on strengthening primary care, realigning incentives to reward higher quality and greater value, investing in preventive care and expanding the use of health information technology. Insurance companies which are bleeding because of what they claim are inflated claims, have been relying on special investigating agencies to verify the authenticity of many of the claims.
Impact on common people
The move by insurance companies to pull out the facility of cashless hospitalization has left the middle class in a reel who do not have ready cash available with them. A study conducted at Banglore based Manipal Hospital and New Delhi based Escorts Heart Institute revealed that more than 70 percent of the health insurance policyholders are relatively poor middle and lower middle class individuals who have giving premiums for the last 10-15 years with hope that they can avail the cashless benefit whenever they require. Medical costs are increasing to such an extent that paying medical bills become difficult.
Most of the state run insurance companies excluded the large hospitals those who have a transparent billing system. The smaller medical hospitals would continue to give the cashless benefits. Is it that indication in the small hospitals bill manipulations are not possible or is it that vested interests are more easily looked after there? We all know that serious injuries like joint replacements, heart surgeries cannot be done on small hospital. It is regrettable that even public sector insurance companies have joined private sector ones in their cold attitude towards their respective customers when large number of hospitals were de listed by these public sector insurance companies for extending the cashless benefits for availing medical facilities through mediclaim policies.
Finally, rather than withdraw cashless hospitalization facility insurance companies should encourage buying the medical insurance so that all the family members are able to avail quality medical treatment, if and when required as in the case of major developed countries in the world such as Canada, Germany, US, UK etc. Such a step would not only help insured avails treatment at the earliest but would also help for regular health check-up. This means that an insured can live healthy lifestyle as compared to uninsured.
The Insurance Regulatory and Development Authority (IRDA) chairman Hari Narayan said on 11 July that it had decided to scrutinize the matter of insurance companies stopping the cashless capability for hospitalization of patients to mediclaim policy holders. IRDA need to quickly implement provisions in the new cashless health reform law and stimulus legislation that focus on strengthening primary care, realigning incentives to reward higher quality and greater value, investing in preventive care and expanding the use of health information technology. Insurance companies which are bleeding because of what they claim are inflated claims, have been relying on special investigating agencies to verify the authenticity of many of the claims.
Impact on common people
The move by insurance companies to pull out the facility of cashless hospitalization has left the middle class in a reel who do not have ready cash available with them. A study conducted at Banglore based Manipal Hospital and New Delhi based Escorts Heart Institute revealed that more than 70 percent of the health insurance policyholders are relatively poor middle and lower middle class individuals who have giving premiums for the last 10-15 years with hope that they can avail the cashless benefit whenever they require. Medical costs are increasing to such an extent that paying medical bills become difficult.
Most of the state run insurance companies excluded the large hospitals those who have a transparent billing system. The smaller medical hospitals would continue to give the cashless benefits. Is it that indication in the small hospitals bill manipulations are not possible or is it that vested interests are more easily looked after there? We all know that serious injuries like joint replacements, heart surgeries cannot be done on small hospital. It is regrettable that even public sector insurance companies have joined private sector ones in their cold attitude towards their respective customers when large number of hospitals were de listed by these public sector insurance companies for extending the cashless benefits for availing medical facilities through mediclaim policies.
Finally, rather than withdraw cashless hospitalization facility insurance companies should encourage buying the medical insurance so that all the family members are able to avail quality medical treatment, if and when required as in the case of major developed countries in the world such as Canada, Germany, US, UK etc. Such a step would not only help insured avails treatment at the earliest but would also help for regular health check-up. This means that an insured can live healthy lifestyle as compared to uninsured.
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