IRDAI Must Step In To Resolve Hospital Body-Insurers Impasse, Says Hercules Advisors’ Aditya Shah
The AHPI’s move stems from disputes over low reimbursement rates and delays in claim settlements by the insurers.
Amid major standoff between hospitals and insurance providers Aditya Shah, the founder of Hercules Advisors, on Wednesday called for urgent intervention by the Insurance Regulatory and Development Authority of India.
This was after the Association of Healthcare Providers India , representing over 15,000 hospitals announced a suspension of cashless hospitalisation services for policyholders of Bajaj Allianz General Insurance, effective from Sept. 1.
The move has raised alarm among customers, who now face the prospect of navigating cumbersome reimbursement processes or paying hefty hospital bills upfront.
Aditya Shah, the founder of Hercules Advisors, on Wednesday called for urgent intervention by the Insurance Regulatory and Development Authority of India.
“The end consumer has to face the brunt of it. Reimbursement claims are difficult and have a lot of deductions. It is unacceptable that 15,000 hospitals have decided to delist at least one insurer. I think the IRDAI needs to step in. There has to be sanity within the system,” he said in a conversation with NDTV Profit.
APHI has also issued a notice to Care Health Insurance asking the company to submit its reply by Aug. 31. If the issue is not addressed within this deadline, AHPI’s member hospitals will withdraw cashless treatment facilities for customers covered by Care Health Insurance policies.
His advice to Bajaj Allianz and Care Health Insurance policyholders is to stay calm and avoid knee-jerk decisions like switching policies.
“Just wait and watch. Don't change the policies. No knee-jerk reaction because portability also has its own set of drawbacks. If the problem is solved well and good, if the problem is not solved, then people must consider portability as an option. But that would be a last-ditch attempt to save the policy,” he emphasised.
He also advised policyholders to keep checking the cashless network and check if any particular hospital is delisted.
“At some point in time, the regulator and the government will step in to help consumers,” he added.
The AHPI’s move stems from disputes over low reimbursement rates and delays in claim settlements by the insurers.
“Mind you, most insurers now keep increasing premiums each year based on medical inflation. And if it is not going to the hospitals, then where it is really going is a big question,” Shah acknowledged.
While accepting the hospitals' grievances over low reimbursement rates, Shah also noted that both parties share responsibility.
“It is not as if the hospitals are not equally to blame for this. Hospitals also irrationally charge and sometimes charge beyond the MOUs (Memorandums of Understanding), thereby raising deductions with the insurers,” he said.
