Insurance companies disregarding guidelines issued by regulator: AHPI

The Association of Healthcare Providers India (AHPI) has accused insurance companies of "unfairly" rejecting claims by patients and blatantly disregarding guidelines laid down by the Insurance Regulatory and Development Authority of India.

The AHPI, which is a collective of hospitals and other healthcare providers, contended that private insurance companies have formed an "alarming cartel".

These companies are collectively discontinuing cashless facilities provided to hospitals, depriving patients of their right to choose treatment and healthcare providers in an arbitrary manner, the AHPI charged in a statement.

The real victims in this situation, the AHPI said, are the insured patients.

As claims are denied, individuals find themselves in urgent need of funds to cover mounting medical expenses, especially those seeking emergency care while private hospitals find themselves grappling with escalating costs and mounting losses due to the conduct of these insurance companies, the association contended.

 

Dr Girdhar Gyani, Director General of AHPI, said, "The AHPI's efforts to rectify this situation have been met with resistance. Multiple complaints have been filed with IRDAI, but no tangible action has been taken yet. Several members from across the nation have also reported similar harassment by insurance companies, prompting us to take these concerns seriously."

"Consequently, we are now considering legal action and approaching the Competition Commission of India to draw attention to these concerning practices. One particularly distressing case that I came across involved the sudden de-empanelment of one of our member hospitals in Delhi by a well-known insurance company. Shockingly, the insurer insisted on substantial discounts from the previously agreed-upon rates, resulting in the de-empanelment without providing a satisfactory justification," Dr Gyani stated.

The AHPI has demanded action against such private insurance companies.