Leading corporate hospitals, which are out of the preferred provider network (PPN) of public sector health insurance firms, will offer standardised treatment packages for nearly 250 procedures to see their PPN status restored soon.
The representatives of hospital chains such as Apollo, Fortis and Max are expected to meet their health insurance counterparts with the new proposals tomorrow.
The move comes after a recent meeting of the heads of the hospitals and the four state-run insurance firms — New India Assurance, United India Insurance, National Insurance and Oriental Insurance — decided to form separate working groups to sort out the pricing issues the insurance firms had with these hospitals.
The groups were expected to sort out a compromise formula within 10 to 30 working days.
The insurance firms had stopped offering cashless services to their policy holders approaching the hospitals that are not in their PPN list as they felt that such hospitals were ‘over charging’ their insured patients.
The hospitals, grouped under industry chambers such as CII and Ficci, had argued that isolated incidents should not be the basis for excluding corporate hospitals from PPN.
More From This Section
“The insurance companies had never raised such an issue before. Now that they have expressed their concerns, we will try to address their problems. Tomorrow’s meeting will not be the final one, but we expect most of the current issues to be solved soon,” a healthcare industry executive, who is part of the negotiations, said today.
The high claim ratio — health insurance claim ratio stood at 130 per cent during 2009-10 — was the main reason for the insurance firms to have a strict scrutiny of the rates being charged by the hospitals for various procedures.