The cashless insurance row

What's cashless health insurance
Each person covered under such a policy is issued a health/identity card. In the cashless system, a policyholder can walk into a hospital listed with the insurer, give the card number and get the treatment without having to stand at the cash counter.

For treatment in non-listed hospitals, a thirdparty administrator's (TPA's) authorisation is required. A TPA verifies your policy details on behalf of the insurer and approves the cashless services. A health insurance policy can be taken by an individual for himself and his family. A company can also take a group policy for its employees and their families.

What has changed now
Recently, four public sector health insurance players - Oriental Insurance, National Insurance, United India Insurance and New India Assurance - decided to withdraw cashless service to 150-odd hospitals, including big names across New Delhi, Mumbai, Chennai and Bangalore, such as Apollo Hospitals, Max Hospitals, Fortis, Breach Candy and Lilavati.

The insurance companies argue that leading corporate hospitals overbill, knowing that the patient is insured. They claim to have shelled out Rs 6,991 crore towards claim settlement while the total premium collected in the last two financial years was only Rs 6,734 crore. The public health insurance firms have over 60 per cent share of the total market in this segment.

What it means for you
Customers with policies from public insurers must find out the list of delisted hospitals. This information is also available on the websites of the insurance companies. For the deli-sted hospitals, you will have to hark back to the earlier practice of paying the hospital first and claiming reimbursement later from the insurance company against proper documentation. Even then you may not be reimbursed the entire amount.

What lies ahead
Talks are on between the insurance firms and de-listed hospitals to resolve the impasse. So far, PSU insurers maintain that they will discontinue the cashless facility to several hospitals. Experts believe that the likely solution will have hospitals re-negotiating charges for various treatment procedures with insurers.