PSU insurers, hospitals agree to restore cashless claims

State-owned insurers and corporate hospitals yesterday agreed to restore with immediate effect cashless medical claims for treatment of emergency cases, but failed to resolve the month-long standoff over remaining settlements.

Dr Naresh Trehan who represented hospital chains at a meeting between the two sides in New Delhi yesterday said treatment for cardiac surgery, intensive care and trauma had been restored forthwith.

During the meeting New India Assurance Company chairman M Ramadoss said a patient in need of emergency and trauma services would be attended to through the cashless scheme in all TPA-empanelled hospitals.

"To avoid any inconvenience to the public, third-party administrators (TPAs) have been instructed to provide this facility to those hospitals that are not part of the preferred provider network (PPN) of hospitals recognised by insurance companies," a PSU official said.

Consumers, who were bearing the brunt of a decision by New India Assurance, Oriental Insurance, United India Insurance and National Insurance will get a measure of relief from the move. The companies had decided to stop cashless insurance reimbursements in a few big hospitals on 1 July. According to the insurers hospitals were overcharging consumers, pushing their business into the red.

Consumers who opted for health cover to avail cashless treatment had little option but to pay for hospitalisation. Around 5 per cent of the 1.2-billion Indian population is estimated to be covered by mediclaim policies of which nearly 70 per cent have signed up with state insurers.