The General Insurance Council introduced “Cashless Everywhere”. Health insurance customers can choose from over 40,000 hospitals across India to get admitted and treated on a cashless basis. Health Insurance buyers can have an amazing experience. Only 63% of patients opt for cashless as of today. From 25th Jan 2024, as “Cashless Everywhere” is introduced, it is expected that the percentage of patients who opt for cashless will be higher by 90%.
Will the Health Insurance experience of buyers see a transformative change from 25th Jan 2024? Or is it too early to celebrate?
When a hospital is under the Preferred Partner Network, it means the insurer has negotiated a package rate for different procedures. It also means that the hospital has agreed to accept those negotiated rates. The approval letter from the insurer clearly should state that “No additional Expenses be collected from insured”. And hospitals must honor the same.
In the majority of the cases, despite the agreement between insurers and hospitals, additional amounts are being collected from the insured. The question that the General Insurance Council should answer is “Will this collection of additional amounts from the insured stop from 25th Jan 2024?” If the answer is “NO”, then, nothing changes.
It is understood that some insurers have separate agreements with different hospitals. As per this agreement, once the bill is settled by the insurer to the hospital with stipulated TAT – Say 3 days, the hospital will give a discount on the bill to the insurer. The problem with this procedure is that while insurers are claiming high loss ratios and increasing their premiums, the pass back from hospitals is not accounted for in the claims ratio or in deciding the renewal premium of Corporate Health Insurance. Further, these insurers are least bothered when hospitals are charging additional amounts from the insured. The question that the General Insurance Council should answer is “Will this non-transparent practice stop from 25th Jan 2024?” If the answer is “NO”, then, nothing changes.
Finally, it has become convenient for Insurers to blame hospitals and hospitals to blame insurers. While insurers are regulated by IRDAI, hospitals have no regulator. Having a hospital regulator would be a key step needed for fairness on behalf of both insurers and hospitals towards patients.
