Apollo, Fortis big exceptions.
Barring the big two healthcare providers, Apollo and Fortis, all other major hospitals that were out of the preferred provider network (PPN) of public sector health insurance companies may find cashless treatment facilities restored to them in a week.
Most of the other hospitals across Delhi, Mumbai, Bangalore and Chennai have renegotiated package rates for healthcare services with the insurance firms, the company officials said.
Apollo and Fortis are yet to come up with their package rates for negotiation, said M Ramadoss, chairman and managing director of New India Assurance Co.
Speaking to reporters on the sidelines of a CII event on health insurance here, Ramadoss said the number of hospitals in the PPN is over 400, as compared to just over 300 before insurance firms decided to negotiate individual health service packages with the hospitals.
Delhi-based Medanta, Max and Ganga Ram hospitals are among those that have already presented their revised package rates to the insurance firms, Ramadoss said.
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The four PSU insurance companies — New India Assurance, Oriental Insurance, United India Insurance and National Insurance Company — had decided to withdraw cashless services in several hospitals of the four metros after the latter were unwilling to renegotiate prices for 42 selected treatment packages, as sought by the insurance companies.
Addressing the CII conference, Fortis managing director Shivinder Mohan Singh said his network of hospitals was not facing any patient drop due to the absence of cashless services. He, Medanta’s Naresh Trehan and Max Hospital’s Pervez Ahmed said the agreement with health insurers was to seen from a long-term industry perspective and from the consumer point of view.
United India Insurance’s chairman and managing director, G Srinivasan, said the decision to put a control over the pricing pattern of service providers arose after healthcare premium, as a percentage of their overall premium inflows, started to rise in a significant manner.
“Initially, the health insurance business used to be only five to 10 per cent of our overall business. Today, it’s over 25 per cent and we expect it to grow to 35 per cent within a few years. That’s why we felt the need to make this profitable,” he said.
Currently, the premium-claim ratio in the health insurance segment is 130 per cent, which means for every Rs 100 collected as premium, companies are spending Rs 130 as medical reimbursement expenses, a loss-making business. The four PSU insurance firms account for the bulk of the health insurance business in the country.