CII says cashless cover issue not yet settled

INDUSTRY BODY Confederation of Indian Industry ( CII) on Friday dismissed reports about the cashless facilities at hospitals being resolved with the public sector undertaking ( PSU) insurers.

" None of the major super- specialty hospitals, including Medanta, have yet signed off with TPA ( third party administrator) on their packaged rates for insurance Companies.

The CII National Committee on Healthcare is in dialogue with PSU insurers," CII said in a statement on Friday.

Reports said private sector hospitals and PSU insurers are likely to arrive at an interim settlement on restoration of cashless treatment facility at major hospitals from Friday on an interim basis. The reports, however, said that it would take some time for the hospitals and four PSU insurance firms to arrive at a final settlement on the vexed issue.

CII said once cashless facilities are restored in the empanelled hospitals, in the second phase hospitals and insurers along with other stakeholders of the health insurance ecosystem and the competent authority would work on a classification of hospitals, which would be agreeable to all.

" There will always be a differential in the levels of care and services provided by hospitals for a single type of illness. A scientific analysis of all these parameters is essential to grade hospitals," Shivinder M. Singh, managing director ( MD), Fortis Healthcare, said.

" After the CII members' meeting with representatives of Raksha TPA on August 12, hospitals in Delhi have worked out the packaged rates for 42 procedures, submitted these to nodal TPA of PSU insurance companies and are waiting for a response," said CII. Dr. Sanjeev Bagai, CEO of Batra Hospital and Medical Research Centre, said, " It is essential that a comprehensive exercise be undertaken of grading hospitals based on their infrastructure, clinical expertise, technology base, clinical outcomes, competency of para- clinical manpower, accreditation and standards of care." " This grading or categorisation of hospitals should then translate into pricing of procedures in each grade. Premature conceptualisation or inference of this complex process must be avoided. A broad consensus and dialogue is of paramount importance," he said.

Currently, there are 449 hospitals across the country under the cashless network.

But corporate hospitals were removed by the PSU insurers from their preferred provider network ( PPN) from July 1.