INDIA MEDICLAIM: Insurers must reveal non-PPN hosps

Mumbai: All public sector health insurance companies will have to disclose the names of hospitals that are not part of the Preferred Provider Network (PPN)—introduced in July 2010—for cashless services and they will also have to cite the reasons for taking them off the old list.     The Central Information Commission passed such an order recently, saying under the Right to Information (RTI) Act, insurance firms will have to reveal all hospital names as people might have bought a mediclaim policy before the PPN system was introduced and going by the list provided by the insurance company at that time, they might still hope to avail of the cashless facility in places 
that have since been deleted. 
    Four public sector insurance firms, New Indian Assurance Company, Oriental Insurance Company, United Indian Insurance and National Insurance Company, started the Preferred Provider Network system on July 1 last year. Under it, the companies offer a fixed rate for 42 kinds of treatments covered under the cashless mediclaim policy. A hospital under PPN will have to offer treatment to a policy holder according to rates fixed by the companies. The new system was implemented to prevent over-billing by hospitals, which the insurance companies claim, was a major reason behind huge losses suffered by them on health insurance portfolio. 'It's appellant's right to know all hosp names' 
Mumbai: Citing the reason behind asking public sector health insurance firms to divulge the names of hospitals which are not part of the Preferred Provider Network (PPN) for cashless services, information commissioner Deepak Sandhu said the firms' obligation could not be restricted to merely specifying the premium amount required to be collected from a policy-holder. Insurance companies, working in a non-transparent fashion, do not divulge all the facilities available to a policy holder by deleting some of the names from their old list of hospitals providing cashless facility. "But it is the appellant's right to know the names of all the hospitals available to them as well as the reason for deleting some of them from the cashless facility list," Sandhu added. 
    RTI activist Chetan Kothari, whose plea brought about the order on July 27, said, "A year ago, I filed an application at the public information office of the New Indian Assurance Company's Tardeo branch, asking why hospital names were not published and the reason behind excluding certain clinics from the facility. Instead of replying, the PIO transferred my application to the first appellate authority and that too, after 30 days. The appellate authority directed the PIO to provide me with the information, but he did not conduct any hearing as prescribed under the RTI Act. Finally, when the data was given out, it was incomplete." 
    Kothari than filed a second appeal before the CIC. "The public sector insurance company had not even provided names and addresses of the chief PIO and the appellate authority on the notice board in its office. Taking strong exception, the CIC ordered the firm to take corrective measures."