Delayed payments hit hospital bottomlines

Cashless medical insurance settlement schemes were impacting the balance-sheets of private hospitals, as delayed payment from insurance companies and third party administrators (TPAs) were eroding profit margins.

According to Rupali Basu, general manager, Wockhardt Hospitals and Kidney Institute, the delay in payments from insurance providers was often as long as nine months.

This was a major problem with cashless insurance schemes. "Cash flow is a problem for private hospitals, as we cannot have delays," she said at a seminar on health insurance organised by the Bengal Chamber of Commerce and Industry.

Basu said reimbursement for cashless treatment should be more than the traditional insurance schemes due to delays in the process.

She said CHGS schemes, or government-sponsored health insurance benefits for government workers, were unacceptable to private hospitals because of the underpayment of medical treatment charges levied by private hospitals by the government.

Surgeries under the scheme were grossly subsidised and unviable for private hospitals. Few private hospitals accepted this scheme, she claimed. Basu's views were echoed by other doctors present on the dais.

Sandip Chaterjee, consultant neuro surgeon of Park Clinic, said cashless mediclaim was becoming "cashless" for medical service provider who were losing money.

Kunal Sarkar of Asia Heart Foundation, while supporting Basu's views, admitted there was need for standardisation of cost in the private health delivery sector, as many hospitals over-charged patients.

He suggested that insurance regulators should have a "muscle power" to stop hospitals from charging excessively from insured patients.

"Standardisation of procedures is a must for hospitals. You must stop doctors from charging irrational cost. The insurance companies should have power to standardise cost," he said.

B D Banerjee, former CMD of Oriental Insurance company and National Insurance Company, and a member of committee for senior citizens insurance at IRDA, said standardisation of medical cost was the need of the hour.

He suggested CHGS costs be raised by 15 - 20 per cent so that private hospitals did not suffer losses.

He said the scheme was under the review of the regulators.