IMA issues advisory to hospitals
New Delhi: The General Insurance Council (GIC) in consultation with general and health insurance companies has recently announced the ‘Cashless Everywhere’ initiative wherein the Hospital Board of India (HBI) and Indian Medical Association (IMA) have claimed that it was impossible to implement the initiative in its present form as it lacks clarity. The GIC last month announced the ‘Cashless Everywhere’ initiative under which, policyholders will be eligible to be treated in any hospital that they choose and a cashless facility will be made available by the insurance company even if the hospital is not in its network. However, the HBI has warned its members that the sustainability of hospitals will be at stake if they accept ‘Cashless Everywhere’ in the current, announced format.
The HBI headquarters in a letter issued to all its branches on Wednesday, stated, “The initiative has been launched without clarifying and clearing the issues raised by the IMA and HBI. Though any policyholder can walk into any hospital that complies with the IRDA guidelines and get treated, there is a one-time, temporary memorandum of understanding (MoU) between the insurance company and hospitals about which there is no clarity. The packages, freebies, discounts on which insurance companies and third-party administrators (TPAs) insist are non-scientific, against the law, and will lead to a compromise on quality and an injustice to patients.” As per the initiatives for elective procedures, the policyholder should inform the insurance company at least 48 hours prior to the admission and within 48 hours of admission during emergency treatment.
Meanwhile, the ongoing debate between hospitals and activists revolves around the proposed rates by insurers and the transparency of hospital charges. Hospitals claim that the rates suggested by insurers do not align with current inflation rates, raising concerns about the financial viability of the proposed reimbursement. On the other hand, activists argue that hospitals often engage in overcharging patients, creating a scenario where patients may have to pay higher costs than necessary.
The Indian Medical Association (IMA) has issued a crucial advisory urging hospitals to reconsider the widespread adoption of this approach. As doctors and healthcare professionals adapt to the evolving healthcare system landscape, the IMA’s advice is important and sparks discussions on how these changes might affect healthcare. The concern & issues as per IMA advisory includes :- The initiative was launched without addressing the concerns raised by IMA HBI (Indian Medical Association – Hospital Board of India); the procedural aspects remain confusing, creating uncertainty in the implementation; while any policyholder can seek treatment in a hospital according to IRDAI guidelines, the existence of a one-time temporary MOU/Letter of Consent between insurance companies and hospitals lacks clear explanations with reference to packages mentioned in CMD Circular 066 (2023-24); There are also concerns regarding the mandatory inclusion of packages, contrary to various court orders; the insistence on packages, freebies, and discounts by the insurance companies and third-party administrators is criticized as illegal and non-scientific. They are compromising the quality of insurance products and being unjust to patients.
| IMA has issued advisory not to adopt the ‘Cashless Everywhere’ approach and the advisories are as follows :-IMA encourages its members to adhere to the minimum suitable charges that are outlined in the annexure. As these charges are carefully calculated based on government standards, they assure hospitals to maintain their financial viability while offering quality care.IMA HBI strongly advises its members to refuse product packages and instead receive payments for actual expenses incurred. By doing so, hospitals can ensure that they are appropriately compensated for the services they offer.IMA also advises its members to go against freebies and discounts or other incentives. This is highly important for offering quality healthcare services to patients.The association suggests focusing more on cashless transactions based on actual expenses incurred by patients. This is to ensure transparency and fairness in the entire healthcare ecosystem.It suggests that insurance companies should determine their eligibility criteria based on the sum insured. Any excess beyond the coverage provided by the policy should be subject to a co-payment by the policyholders, aligning the financial responsibility between patients and insurance providers.Hospitals and other medical institutions need to exercise caution while considering unviable packages offered by Insurance Companies (ICs) or Third-party Administrators (TPA) as they may pose financial risks to the organizations.IMA HBI also says that in case the hospital/medical institution wishes to accept and adopt the ‘Cashless Everywhere’ initiative, they have to beat the potential risks on their own. Therefore, it is advisable to carefully consider the consequences before fully embracing the system. |