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Insurers force hospitals to trim hefty bills NEW DELHI: Vishal, a marketing professional, underwent heart bypass surgery last month at a multi-specialty hospital in NCR and was billed Rs 2.60 lakh. When he approached the insurance company for reimbursement, the hospital was made to refund Rs 35,000 while the insurer paid Rs 2.25 lakh, the rate fixed for the procedure. Until last year, several hospitals had a dual billing structure where patients who were covered under insurance were subject to a higher tariff. The insurance industry responded to this dual billing by introducing its own rate card and created a panel of approved hospitals for cashless treatments which they termed as the preferred provider network (PPN). After the big face-off between insurance companies and hospitals last year, patients are beginning to benefit from the standardized cost structure introduced for common medical procedures. Now increasingly, insured patients do not have to bear any part of the hospitalization cost, unlike in the past. In cases of inflated billing, insurers are getting hospitals to refund the overcharged amount to patients. The other positive fallout is that the claims bill for insurance companies has come down and this in turn will reduce the pressure on health insurance rates and keep them in check. Back |
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