 "Deposits charged by hospitals in cash-less plans to see a decline")
The practice of charging a deposit in cash-less policies by hospitals might see a decline after the new health regulations are implemented from October.
With the Insurance Regulatory and Development Authority (Irda)’s new health norms mentioning a list of 199 items to be excluded from those being payable by insurance companies, sector officials believe the practice of collecting such deposits will come down.
In India, hospitals charge deposits from customers before they are admitted. While in normal circumstances customers are not required to pay any cash if they have taken a cash-less policy, it has been observed that some hospitals ask such customers to pay a flat deposit. This deposit amount charged by hospitals depends on the type of surgery and the choice of hospitalisation made.
Sanjay Datta, head-underwriting and claims at ICICI Lombard General Insurance, said with the health regulations explicitly mentioning the list of non-payable charges, the deposit that is sought from customers will see a decline.
Cash-less policy means an insurance policy where the insurer pays for the policyholder’s cost of hospitalisation without the patient having to pay anything in advance to the hospital.
Rajeev Boudhankar, vice-president, Kohinoor Hospitals, said they had to charge a deposit amount even if the patient had a cashless policy. “This is because many a time the insurers don’t pay certain treatments and customers are unaware of their policy exclusions. Hospitals, being intermediaries, lose a lot of money if insurers don’t pay for their customer’s hospitalisation. Hence, we take deposit in advance to cover such losses.”
Other hospitals also confirmed this. The senior director of a large south-Mumbai hospital said while they charge a deposit from customers, with exclusions being explicitly mentioned, the quantum would significantly decrease. He said since certain procedures and services have been excluded from coverage, customers would have to pay for them and, hence, there was little need of collecting a deposit.
“Earlier, there were disputes that would arise between us and the insurer on whether a particular item is payable by them or not. In some cases, we would have to bear these losses, since the customer cannot be contacted later for making payments for these services which are over-and-above the standard medical expenses. With changes being made, this practice is expected to wane out,” he said.
A standard nomenclature for critical illnesses has been proposed for hospitals and insurers as well to follow, so that customers do not face any difficulty while taking a policy. Cancer, coma, first heart attack, kidney failure and organ transplant are some of the diseases mentioned in critical illness category. The regulator has allowed certain exclusions of disease conditions and procedures in 11 critical illnesses, including skin cancer and HIV induced diseases.
Patients also face problems, since they are not aware of the expenses excluded in such indemnity policies. To curb this anomaly, Irda has proposed that a standard list of exclusions in such hospitalisation indemnity, including areas like baby/infant food, cold/hot packs, water, telephone, bandage, antiseptic lotion and cotton, internet charges, diaper charges among others.
The regulator has allowed the companies to include the excluded items of payment based on product design or as part of hospital expenses. If a company wants to include these excluded items in their policy, they can do so by imposing additional charges.
With the Insurance Regulatory and Development Authority (Irda)’s new health norms mentioning a list of 199 items to be excluded from those being payable by insurance companies, sector officials believe the practice of collecting such deposits will come down.
In India, hospitals charge deposits from customers before they are admitted. While in normal circumstances customers are not required to pay any cash if they have taken a cash-less policy, it has been observed that some hospitals ask such customers to pay a flat deposit. This deposit amount charged by hospitals depends on the type of surgery and the choice of hospitalisation made.
Sanjay Datta, head-underwriting and claims at ICICI Lombard General Insurance, said with the health regulations explicitly mentioning the list of non-payable charges, the deposit that is sought from customers will see a decline.
Cash-less policy means an insurance policy where the insurer pays for the policyholder’s cost of hospitalisation without the patient having to pay anything in advance to the hospital.
Rajeev Boudhankar, vice-president, Kohinoor Hospitals, said they had to charge a deposit amount even if the patient had a cashless policy. “This is because many a time the insurers don’t pay certain treatments and customers are unaware of their policy exclusions. Hospitals, being intermediaries, lose a lot of money if insurers don’t pay for their customer’s hospitalisation. Hence, we take deposit in advance to cover such losses.”
Other hospitals also confirmed this. The senior director of a large south-Mumbai hospital said while they charge a deposit from customers, with exclusions being explicitly mentioned, the quantum would significantly decrease. He said since certain procedures and services have been excluded from coverage, customers would have to pay for them and, hence, there was little need of collecting a deposit.
“Earlier, there were disputes that would arise between us and the insurer on whether a particular item is payable by them or not. In some cases, we would have to bear these losses, since the customer cannot be contacted later for making payments for these services which are over-and-above the standard medical expenses. With changes being made, this practice is expected to wane out,” he said.
A standard nomenclature for critical illnesses has been proposed for hospitals and insurers as well to follow, so that customers do not face any difficulty while taking a policy. Cancer, coma, first heart attack, kidney failure and organ transplant are some of the diseases mentioned in critical illness category. The regulator has allowed certain exclusions of disease conditions and procedures in 11 critical illnesses, including skin cancer and HIV induced diseases.
Patients also face problems, since they are not aware of the expenses excluded in such indemnity policies. To curb this anomaly, Irda has proposed that a standard list of exclusions in such hospitalisation indemnity, including areas like baby/infant food, cold/hot packs, water, telephone, bandage, antiseptic lotion and cotton, internet charges, diaper charges among others.
The regulator has allowed the companies to include the excluded items of payment based on product design or as part of hospital expenses. If a company wants to include these excluded items in their policy, they can do so by imposing additional charges.