Association Of Healthcare Providers To Meet Bajaj Allianz Over Reimbursement Cost Impasse

The Association of Healthcare Providers has said that they are likely to meet representatives from Bajaj Allianz on Thursday to discuss the suspension of cashless services.

Members of the core committee of the Association of Healthcare Providers - India, will meet the representatives and withdraw the advisory to suspend cashless services for the company's policyholders if there is an agreement, Dr. Girdhar Gyani, director general at AHPI, told NDTV Profit.

Care Health Insurance too has been issued with a notice which they are scheduled to reply to by August 28, Gyani said. "Once we are able to sort out issues with Bajaj Allianz and Care, we will see how to tackle similar issues with others insurers," Gyani said.

"We are surprised by this announcement," Bhaskar Nerurkar, Head of the Health Administration Team at Bajaj Allianz General Insurance, said, adding that the company is proactively engaging with all hospitals to settle any queries or dues.

"We are confident of working amicably with AHPI and its member hospitals to arrive at a solution that is in the best interests of our customers," he said.

Manish Dodeja, Chief Operating Officer at Care Health Insurance, also said that while the company has received a mail from the AHPI, the communication is generic and does not carry any details such as, names of affected providers, tariff or claim deduction challenges, etc. The company is in touch with the forum for specific information and is confident of amicably resolving any issues, Dodeja said.

The AHPI representing hospitals and healthcare institutions across the country, has decided to advise its member hospitals to stop providing cashless treatment facilities for policyholders of Bajaj Allianz General Insurance Company, with effect from September 1, 2025.

The advisory follows complaints from AHPI member hospitals that Bajaj Allianz General Insurance Company has refused to revise hospital reimbursement rates in line with rising medical costs, a press release by the hospital association said.

Earlier, when there was no Ayushman Bharat, hospitals would get money directly from the patient or private insurance. Insurance was dependent on the agreement arrived with the hospital, which was in line with the market price for treatments offered, explained Gyani. In some cases, the insurance company was able to negotiate a bulk discount of 10-20%.

Now, with the government coming forward with numerous schemes, it offers treatments at a fraction of the costs and the cross subsidy model is not working, Gyani said. Private insurers too are entering into agreements on lower rates and giving less money to hospitals, and not revising these reimbursement rates.

There are instances where on a Rs 3 lakh bill, the insurance company can deduct Rs 60,000-70,000, which either the hospital pays or the patient pays. There is also often a delay in discharge of patients.

"Member hospitals have got these issues to our notice, as a consequence of which such advisories have been issued," Gyani said. The association had issued a notice to Bajaj Allianz General Insurance giving them time till August 18, and reached out to them on August 22. The upcoming discussions with Bajaj Allianz and Care will decide the course on how to tackle these issues with other insurance players, Gyani said.