Ten days after the Ahmedabad Hospitals and Nursing Properties Affiliation (AHNA) suspended cashless providers for 3 main medical insurance corporations, alleging harassment of hospitals and sufferers by these companies, the tug-of-war between the healthcare suppliers and healthcare insurers appears to have solely taken a flip for the more severe.
Whereas at the least one of many insurers has despatched a authorized discover to the AHNA, the affiliation stated it might widen its protest to make sure its situations are met.
In a press convention performed by AHNA on Saturday, its consultant reiterated that the suspension of cashless providers imposed by the grouping for coverage holders of Star Well being Insurance coverage, Tata AIG, and Care Well being Insurance coverage would proceed if their calls for weren’t met. The suspension started on April 2.
The Indian Categorical has additionally discovered that Tata AIG despatched a authorized discover to AHNA concerning claims made within the media. The identical was confirmed by AHNA President, Dr Bharat Gadhavi.
The main complaints of hospitals within the AHNA grouping embrace “arbitrary exclusion/delisting of hospitals by these insurance coverage corporations, non-revision of expenses for a few years, in addition to beforehand issued ‘Authorisation Letters’ for cashless therapy being disowned by the businesses resulting in skirmishes between the hospital and the sufferers.”
Dr Gadhavi stated AHNA had obtained letters of help from the Gujarat State Department of the Indian Medical Affiliation (IMA-GSB) and the Ahmedabad Medical Affiliation (AMA) moreover comparable grouping of hospitals from Rajasthan, Uttar Pradesh, Madhya Pradesh and Punjab.
Dr Gadhavi stated that the suspension of cashless providers would proceed till these corporations took steps to rectify their complaints.
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In a press release on Saturday night, Tata AIG stated, “TATA AIG categorically refutes the claims made by AHNA as unsubstantiated, deceptive, and factually incorrect… Some hospitals had been discovered to be concerned in malpractices therefore they had been delisted by TATA AIG. Such actions are crucial to guard policyholders from inflated prices that in the end affect insurance coverage premiums…Our hospital empanelment course of and therapy charge negotiations adhere to IRDAI tips, guaranteeing affordability and common entry to high quality healthcare.”
An announcement from Star Well being Insurance coverage, threatening authorized motion, said, “Star Well being Insurance coverage firmly rejects the baseless allegations made by AHNA. Cashless providers proceed seamlessly throughout Gujarat, in cities reminiscent of Ahmedabad (together with suppliers related to AHNA) , Vadodara, Surat, and different cities. Our clients face no disruption. Regardless of our responses to AHNA’s earlier claims, the affiliation has made no effort to have interaction with us straight. AHNA’s repeated makes an attempt to mislead the general public are irresponsible and unwarranted…Makes an attempt to break our fame might be handled by means of acceptable authorized motion.”
The AHNA assertion, in the meantime, learn, “Insurance coverage firm won’t exclude or delist any member Hospital except there are authorized grounds for which actions have been taken by the Authorities… A discover must be served to the Hospital earlier than initiating any motion.”
It additional stated, “Revision of expenses might be executed yearly as per the healthcare inflation charge. Whereas negotiating tariffs with the Hospital/Nursing Properties, no low cost must be requested for in pharmacy, consumables and implants.”
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The 4 factors on claims embrace, “The Insurance coverage firm will honour the Authorisation Letter’s (AL) phrases and situations and the quantity authorised, and pay accordingly. There must be no deduction after the AL is issued. Any queries to be raised solely earlier than the Authorisation Letter is issued. The queries must be raised by an equally competent and equally certified physician. No queries as soon as the AL is issued. The insurance coverage firm might be accountable to find out if the affected person has any pre-existing situations and if this has any affect on the declare, the identical must be conveyed to the sufferers by the insurance coverage firm. Well timed cost might be made with none deductions.”
