Mumbai: Non-life insurance companies have moved a step closer to launching common empanelment of hospitals to check spiraling health insurance claim costs. The General Insurance Council (GICl), a self-regulatory body of non-life and pure health insurance companies had appointed consulting firm PwC to come out with indicative rates for various medical procedures. The consulting firm has just submitted its report containing indicative pricing for the 23 most common procedures that bring the maximum claims. The study analysed the claims data for each procedure to come out with the average cost of each procedure.
Speaking to DC, an insurance official said, “The indicative pricing depends on the location where treatment is being sought. For example the hospital in a Tier 1 city or Tier 2 or 3 city, the type of facilities a hospital has, is the hospital a super specialty hospital, and other factors. For patients with co-morbidities, the treatment cost over and above the fixed charges will be considered.”
“The hospitals cannot force high treatment costs on insured patients nor can we force our pricing on them. Insurers will be free to negotiate with the hospitals and onboard them on these indicative rates,” added the official.
Meanwhile, insurers welcomed the Supreme Court’s order asking the central government to standardise rates for medical procedures across all states. This directive followed a PIL filed by an NGO highlighting significant disparity in hospital rates.
“The SC is warning hospitals that they should charge reasonably.
Hospitals make patients undergo unnecessary tests, charge insured patients differently compared to uninsured patients, and also
overcharge. So, there has to be a standard protocol for the treatment of diseases. The brunt of these malpractices is borne by policyholders as their premium goes up if insurers suffer losses in the health business,” said an official.
Tapan Singhel, chairman of GICL said, “We have always maintained that we need to charge an appropriate cost for customers whether it's at the time of taking out a policy or bearing certain expenses at the time of a claim. It is very encouraging to see the Apex Court urging the centre to take a decision on standard hospital rates.”
Today 51 per cent of the health insurance claims settled are cashless while the remaining 49 per cent of claims are reimbursement.
