New Delhi: Hospitals in North India are set to resume cashless services for Bajaj Allianz policyholders after the industry lobby AHPI successfully resolved its ongoing dispute with the insurer over reimbursement and tariffs rates.
Following a meeting with Bajaj Allianz General Insurance Company, AHPI announced that, “there was broad agreement on all the issues and the Bajaj Allianz has agreed to address various concerns with formal actions and with their commitment …”we withdraw suspension notice served on Bajaj Allianz with immediate effect.”
Confirming the development Dr. Tapan Singhel, MD ad CEO Bajaj Allianz General Insurance Co. Ltd said, “We are pleased that the matter has been resolved in the interest of policyholders and citizens who must never face interruptions in their access to cashless healthcare.”
“Insurers have always worked directly with hospitals to address operational realities and we will continue to do so in a spirit of partnership,” he added.
Under its umbrella, the Association of Healthcare Providers of India (AHPI) has over 15,000 member hospitals including leading listed corporate chains such as Max, Fortis etc.
The agreement comes days after the hospitals’ body had directed its member hospitals to temporarily halt cashless services for the insurer’s policyholders, citing a dispute over reimbursement rates and alleging predatory pricing tactics.
“Insurers have not revised rates for years leading to undue financial stress on the hospitals and are coming with their own rates using collective bargaining to pressurize the hospitals, the body had stated.
Our member hospitals are being told to reduce rates further and are being “threatened” that unless they reduce rates, cashless services will be stopped, it added.
Additionally AHPI, also alleged that, “the insurers are increasingly questioning clinical decisions of the treating doctors pushing for the usage of cheaper drugs/implants, which may not be in the interest of the patient.”
According to AHPI, India experiences an annual medical inflation of 7-8 per cent driven by rising prices of consumables, utilities, and other overheads and continuing on the same rates creating an unsustainable situation for healthcare providers.
Meanwhile, insurers counter this with their argument with opaque pricing model leading to variation in the cost of services and have long called for establishing a regulator to standardize treatment costs, and resolve disputes.
Several insurers also outline to onboard hospitals on the National Health Claims Exchange, (NHCX) where insurers are already listed to bring transparency in pricing for consumers.
Notably, NHCX, a digital health insurance claim platform developed by the Ministry of Health and Family provides a centralized single gateway to streamline and standardize claim processing for health insurance claims in the country.
Besides Ayushman—a govt funded insurance scheme—the centralized platform also covers private reimbursement claims with the requirement of registration of insurers and Third-Party Administrators (TPAs) on the portal.
