Insured may have to part-pay medical bills

Other proposals include grading of hospitals, expanding network.

Here’s some bad news for health insurance policy holders. Insurance companies may no longer foot the entire bill for your hospitalisation expenses.

Insurance companies have proposed that the insured should part-pay the bills during claims. The proposal was discussed at a meeting organised by the Confederation of Indian Industry (CII) here today. The meeting was held in the backdrop of the recent stand-off between insurance companies and hospitals over inflated bills.

Among others, the proposals also included creation of six to seven categories of hospitals, based on their infrastructure, number of beds, speciality focus, and clinical and diagnostic capabilities. Health insurance companies will settle the claim based on a hospital’s grade.

In other words, even the treatment cost in a small hospital for a particular illness could be similar to that of a bigger one with advance medical infrastructure and better facilities.

Fortis Healthcare CEO Vishal Bali, who attended the meeting, said: “The proposals, if implemented, will help in demarcating the charges of different hospitals, depending on the services and facilities provided. This will protect the interest of both hospitals, insurance companies, third party agents and consumers.”

At present, there is no set standard on the money a hospital can charge. This is largely a grey area, which led to a number of conflicts between hospitals and insurance companies in the recent past.

From July 1, public sector insurers had taken off over 100 hospitals from the list of the Preferred Provider Network (PPN). There were claims that hospitals were inflating bills exorbitantly leading to significant losses. The insurance companies have been making losses, as they claim many small hospitals inflate their bills if a patient has cashless medical insurance. Due to this, the industry ended up paying Rs 11,000 crore on the premium collection of Rs 8,000 crore.