IRDA on Well-being coverage cashless dispute

The Insurance Regulatory and Development Authority (IRDA) Friday claims the issue of offering cashless treatment under health and fitness insurance cover policies issued from the four government-owned general insurers 'is acquiring resolved'. IRDA Chairman J. Hari Narayan said that prior to dispute there were only 300 federal government owned insurers as compared to 400 now. The four government-owned non living insurers had earlier delisted key hospital chains from offering cashless hospitalization facility for their health and fitness insurance plans policy holders on the ground that the hospitals are over charging the patients. He was in Chennai to launch the country's very first wellbeing cum life health care insurance product introduced through the city-based Star Physical condition and Allied Coverage Enterprise Ltd partnering with private existence insurer Shriram Living Coverage Organization Ltd. when he clarified. There are talks of creation of separate regulator for the healthcare sector. Also, Confederation of Indian Business (CII) has explained none in the main super speciality hospitals have signed using the Raksha TPA (third party administrator). CII's members are waiting for the response from the insurers along with the TPA given that the meeting Raksha in Delhi. As on August 12, the hospitals in Delhi have worked out the packaged rates for 42 procedures and submitted towards the TPA. As soon as cashless is restored within the empanelled hospitals, in the second phase, hospitals and insurers together with other stakeholders from the well-being coverage ecosystem as well as competent authority would work on a classification of hospitals, which will be agreeable to all. The other side: Shivinder M. Singh, managing director, Fortis Healthcare stated 'There will usually be a differential from the levels of care and services provided by hospitals to get a single type of illness. This differential is really a function of structures, processes and outcomes. A scientific analysis of all these parameters is essential to grade hospitals.' Sanjeev Bagai, CEO, Batra Hospital and Medical Research Centre claims, 'This grading or categorization of hospitals will need to then translate into pricing of procedures in each grade. Premature conceptualization or inference of this complex method should be avoided'. It's critical that a comprehensive physical exercise be undertaken of grading hospitals based on their infrastructure, clinical expertise, technology base, clinical outcomes, competency of para-clinical man power, accreditation and standards of care is accomplished.