Covid-19 patients in the city are discovering to their chagrin that the cashless claim facility provided by their insurers may not be honored by hospitals, adding to their anguish at a time of crisis. Panic-stricken family members arranging large sums of cash at the eleventh hour as critical patients waited to be treated due to hospitals wouldn’t accept cashless settlement of hospital bills by the insurance companies.
Due to the Covid-19 infection, my father required immediate hospitalization because of his lungs were affected,” Rajiv Sriram told Hello Vizag, recounting their trouble after his father tested positive on 14th August. On being denied a cashless claim for a Covid-19 patient in a private hospital, I had to arrange for money by borrowing from my relatives and friends overnight. I was asked to deposit Rs 1 lakh at the time of admission, said Rajiv, 35, floor supervisor in Big Bazaar.
Rajiv soon found that if hospitals deny cashless facility, there is not much that the insurance company can do. Only on paper, insurance companies publish all the network of hospitals that accept cashless admissions, yet they have little control if the hospitals choose to stop the facility. Two days on the trot, Rajiv looked for private hospitals that would accept cashless claims without success. Karri Prasad, 34 of Madhavadhara also faced a similar distressing situation when one of his family members tested positive for the virus.
In view of the situation, the family decided to check with the public health authorities and managed to get the patient admitted to a government hospital. Most of the private hospitals, Hello Vizag spoke, said their hands are tied. Speaking on condition of anonymity, a doctor working for a private hospital said, old rates offered by insurance companies for the settlement of bills sent by the hospital authorities are not synching with our revenue generation model amid the Covid-19 pandemic. So we have come up with standard rates and if they are acceptable to insurance companies, hospitals are very much happy to process the cashless treatment.
Similar incidents were brought to light by many to IRDA by writing umpteen letters. But many private practitioners opined that one of the possible reasons for cashless claims are being denied, could be the insurance firm and the hospital are not in agreement over the rates for Covid-19 treatment. But some insurers said the denials are not as widespread as expected. If the private hospitals are denying to cashless claims, it is not the insurer’s decision.
The other reasons for denying of cashless treatment in some Corporate/private hospitals, according to financial experts, many corporate hospitals don’t want to show full and specific charges on record and consequently, they demand some part of the amount should be paid in the form of cash deposit and the remaining balance amount will be claimed later. It is a known fact that Insurance claims attract taxes and thus, they are deliberately avoiding cashless transactions. In case, if a patient demands admission, they clearly say about the non-availability of beds.
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