IRDA proposes rating of hospitals

The Insurance Regulatory and Development Authority (IRDA) will shortly submit a proposal to the ministry of health for rating hospitals across the country.

"We have been receiving complaints against hospitals regarding improper billing while settling insurance claims. A rating mechanism will allow insurance companies to assess the billing done by hospitals for the purpose of settling claims. We will submit our proposal to the health ministry within the next couple of months," TK Banerjee, member, IRDA, told Business Standard.

"At present the tariff advisory committee is collecting various data needed for the proposal," he added.

Settling health insurance claims is fast becoming a trouble spot for consumers and insurance companies as there is no basis for evaluating the billing done by the hospitals.

This is partly to blame for the delay in settlement of claims and also for insurance companies not accepting full claims.

"There are some hospitals that charge Rs 4,000 for one treatment and some other hospitals charge Rs 20,000 for the same treatment. We are examining how the hospitals can be rated. Some sort of grading, as is done in hotels and restaurants, would be useful. This would give insurance companies better basis for evaluating the claims," he said.

At present, the scope of the proposed rating is not clear. It could only be limited to ratings based on the fees charged by the hospitals or it could also cover other qualitative aspects.

The discussions with the ministry of health would crystalise the direction of the proposal. Elaborating on the need for a rating, Banerjee said the problem in case of hospitals was that they were governed under concurrent laws with both the Centre and states exercising jurisdiction.