City nursing homes to lift ban on cashless mediclaim

After a gap of two years, nursing homes across the city are all set to lift the ban on cashless mediclaim facility through private insurance companies. The move will bring major relief to lakhs of patients who could not avail cashless benefits for undergoing medical procedures.

The Association of Medical Consultants (AMC) is in talks with more than five private insurance companies to work out modalities that are profitable for all parties - patients, health care providers and insurance companies.

AMC president Dr Kishore Adyanthaya said, "Discussions are on with multiple private insurance companies. We want the patients to be benefited at the end." Bajaj Allainz, Future Generali, ICICI Lombard, Star Health and Max Bupa are some of the insurance companies who have met the AMC members. Sources said that a MoU would be signed with one of the companies and other would follow suit.

Nursing homes in the city had banned the cashless mediclaim facility in July 2010 after the concept of Preferred Provider Network (PPN) was introduced by the government-owned insurance companies.

The four public sector insurance companies - New India Assurance, Oriental Insurance, UnitedIndia Insurance and National Insurance - under the PPN programme made a fixed tariff rate card for all medical procedures.

The healthcare providers were upset since the rates were slashed up to 30 per cent for nursing homes and 50 per cent for bigger hospitals.

"The rates were fixed without considering factors like location of the nursing home or hospital, experience of the doctors, severity of the ailments etc. We obviously refused," said AMC's vice-president Dr Sudhir Naik.

Healthcare providers are now confident that the public sector companies will be flexible with the PPN programme. "Till now, the consumer was bearing the brunt of the tussle between the healthcare providers and insurance companies. However now the consumer is more powerful with the insurance portability option," said Naik.

The insurance companies were of a view that healthcare providers have been charging 'enormously' to insured patients. While the healthcare providers have been denying this, the AMC is now working on a concept called Network of AMC Hospitals (NOAH) which will guarantee transparency is medical treatment and billing as well.