Private hospitals to stop CGHS cashless scheme from March 7

March 7, 2014 by · Leave a Comment
Filed under: Announcements, Healthcare 

Source : http://timesofindia.indiatimes.com/india/Private-hospitals-to-stop-CGHS-cashless-scheme-from-March-7/articleshow/31438842.cms

The move will affect 50 lakh serving employees and over 30 lakh pensioners, as well as their family members.

BANGALORE: In a blow to government employees, including those who have retired, the Central Government Health Service has announced withdrawal of cashless medical service in private hospitals empanelled with the CGHS scheme from March 7. Patients will henceforth have to cough up hospital charges and later claim the amount from the government, according to the new rule.

The move will affect 50 lakh serving employees and over 30 lakh pensioners, as well as their family members. At a conservative estimate, the total number of persons affected could well be over two crore.

The move was necessary, said the Association of Healthcare Providers India (or AHPI, the nodal body of private empanelled hospitals) for a number of reasons, the main ones being CGHS owes these hospitals around Rs 200 crore in unpaid services as well as “unreasonably low” CGHS tariffs that haven’t been revised for the last four years. A doctor’s consultation fee, for example, remains Rs 58.

Also, AHPI says CGHS makes “illegal” deductions of 10% on all payments leading to losses for member hospitals. AHPI claims the amount runs up to Rs 180 crore.

In Karnataka, 20 hospitals, all in Bangalore, are empanelled with AHPI. HCG, Apollo hospitals, MS Ramaiah Memorial Hospital and Bangalore Baptist Hospital, among others, will not provide the cashless health scheme from March 7.

“When we were empanelled with the government, it was agreed upon that we will get 10% rebate on treatment charges if the government pays within seven days. But now, this deduction has been made applicable even when the amount is unpaid for years. That’s illegal. This has led to huge losses for member hospitals amounting to over Rs 180 crore over the past three years,” says Dr Alexander Thomas, CEO, Bangalore Baptist hospital, who represents AHPI in Bangalore.

Some hospitals have put up a public notice to this effect, reading, “CGHS tariffs are unreasonably low and not been revised for the last four years, threatening the very existence of the medical service providers.”

Dr Naresh Shetty of AHPI said, “The empanelled hospitals have been providing services under most difficult circumstances. They had to deal with steep hikes in electricity and water tariff, consumables, wages, taxes. We’ve been requesting a revision since June 2013 but there’s been no response.”

Official speak

The dues are just one issue. The bigger issue is that a doctor’s consultation charge of Rs 58 is appalling. The fees for several procedures are abysmally low. We don’t want to let down our beneficiaries but we have no choice. We ask the CGHS to consider the rates of the National Accreditation Board for Hospitals & Healthcare Providers. We’ve suggested that if at all CGHS were to take tender route, let CGHS decide the rates based on lowest bid received from NABH – accredited hospitals. Adopting rates like this would be logical and rational. Treating a patient can’t be made similar to selling onions and potatoes.

IRDA comes up with landmark draft health insurance regulations – Moneylife Personal Finance site and magazine

May 31, 2012 by · Leave a Comment
Filed under: Uncategorized 

IRDA comes up with landmark draft health insurance regulations – Moneylife Personal Finance site and magazine.

Ayurveda, unani treatments under mediclaim umbrella

July 26, 2011 by · 2 Comments
Filed under: Uncategorized 

Till some time back, health insurance policies used to cover only allopathy treatment while ayurveda, homeopathy, naturopathy and unani treatmentswere left out of the ambit. Despite having a comprehensive health insurance planin place, individuals who preferred such systems had to pay out of their own pockets.

These policyholders can now breathe easy as some insurance companies have started including such alternative forms of treatment under their cover, especially ayurveda. “Ayurveda being the most prevalent of the alternate systems, we have designed a product to cover treatments under ayurvedic hospitalization,” says S S Gopalarathnam, managing director, Cholamandalam MS General Insurance.

While some insurers only offer it under their group policies, others have started offering the facility to individual health insurance seekers. PSU insurer New India Assurance and standalone health insurance provider Star Health and Allied Insurance are other insurance companies that have started covering ayurvedic treatments under individual policies. ICICI Lombard General Insurance covers it under government scheme and Future Generali Insurance offers it to corporate group insurance buyers from which employees of the covered company can benefit.

“Our policies as such do not cover any other line of treatment other than allopathy. However, in group policies, if requested for we do offer tailor-made packages to corporate clients to cover ayurvedic treatment subject to certain conditions,” explains Shreeraj Deshpande, head, health insurance, Future Generali.

How did this need to cover alternative forms of medicine in health insurance arise? Gopalarathnam, explains, “During various focus group discussions with customers and agents, we found that for chronic ailments like spondilytis, arthritis and epilepsy, many people preferred alternate streams of treatment such as ayurveda, siddha and homeopathy etc.”

Though the coverage has been expanded, there are curbs on the amount and situations under which it can be claimed.

New India Assurance’s extends cover to individuals undergoing treatment with the help of Ayurvedic, homeopathic and Unani systems of medicine. “Such claims will be covered only to the extent of 25% of sum insured. Also, they need to have availed of the treatment at a government hospital to be eligible for the claim,” informs Segar Sampathkumar, deputy general manager, New India Assurance.

Source : http://articles.timesofindia.indiatimes.com/2011-07-25/india/29811849_1_shreeraj-deshpande-star-health-psu-insurer

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