Mumbai: Private hospitals, including large ones, are resisting a move by insurers and the General Insurance Council (GIC) to roll out a common empanelment, saying the proposed framework does not address the concerns on claim settlement and pricing.
The Federation of Private Hospitals and Nursing Homes Associations of India, which represents around 150,000 hospitals across 12 states, has recently written to the GlC arguing that the framework was drafted without adequate consultation. The group flagged clauses on operational terms, charges, and package rates calling it impractical. While insurers are expecting 20,000 hospitals to join the panel, the large ones are giving it a miss.
Key concerns include lack of clarity on tariffs, absence of a redressal mechanism for short payments. "We have been told that the lowest tariff signed with any one insurer will be applied across all 14 companies. Most rates have not been revised since 2017, despite medical inflation," HM Prasanna, president of the FPHNHAI, said.
While the association is not opposing the concept of a common empanelment, it has advised members to refrain from signing the agreement until revisions are made. "We just want it implemented in a healthy way after deliberations on several issues including claims settlement," said Prasanna.
Friction over claim rejections and deductions has been a matter of dispute in places like Ahmedabad, where hospitals accused insurers including Star Health, Care, and Tata AIG of arbitrary denials and delisting without notice, prompting threats to suspend cashless facilities.
In FY24, general and health insurers settled 26.9 million claims worth ₹83,493 crore, with two-thirds processed through cashless mode. The GI Council initiated process for increasing cashless claim settlements almost two years back under health policies, common empanelment of all hospitals under one platform and negotiations with hospitals on charging reasonable rates.
"We have had many meetings with provider bodies, and we have instituted a dispute resolution forum for hospitals which have not been paid even after a cashless authorisation," said Segar Sampathkumar, director, health, General Insurance Council.
The Federation of Private Hospitals and Nursing Homes Associations of India, which represents around 150,000 hospitals across 12 states, has recently written to the GlC arguing that the framework was drafted without adequate consultation. The group flagged clauses on operational terms, charges, and package rates calling it impractical. While insurers are expecting 20,000 hospitals to join the panel, the large ones are giving it a miss.
Key concerns include lack of clarity on tariffs, absence of a redressal mechanism for short payments. "We have been told that the lowest tariff signed with any one insurer will be applied across all 14 companies. Most rates have not been revised since 2017, despite medical inflation," HM Prasanna, president of the FPHNHAI, said.
While the association is not opposing the concept of a common empanelment, it has advised members to refrain from signing the agreement until revisions are made. "We just want it implemented in a healthy way after deliberations on several issues including claims settlement," said Prasanna.
Friction over claim rejections and deductions has been a matter of dispute in places like Ahmedabad, where hospitals accused insurers including Star Health, Care, and Tata AIG of arbitrary denials and delisting without notice, prompting threats to suspend cashless facilities.
In FY24, general and health insurers settled 26.9 million claims worth ₹83,493 crore, with two-thirds processed through cashless mode. The GI Council initiated process for increasing cashless claim settlements almost two years back under health policies, common empanelment of all hospitals under one platform and negotiations with hospitals on charging reasonable rates.
"We have had many meetings with provider bodies, and we have instituted a dispute resolution forum for hospitals which have not been paid even after a cashless authorisation," said Segar Sampathkumar, director, health, General Insurance Council.
