Decks being cleared for cashless medical insurance at nursing homes

The Association of Medical Consultants (AMC) has organised themselves into a cohesive group so that those with medical insurance can get cashless service at nursing homes run by them in Mumbai.

This move is aimed at resolving the stand off between insurance companies, third party administrators (TPAs) and nursing homes on extending cashless medical insurance.

The group has been christened Network of AMC Hospitals (NoAH).

In 2010, the four public sector general insurance companies  New India Assurance, Oriental Insurance, United India Insurance and National Insurance  which control 70 per cent of the Rs 13,000-crore health-insurance market formed a Preferred Provider Network (PPN) with big hospitals. They negotiated package rates for some of the procedures/hospitalisation expenses, which are commonly claimed under health insurance policies.Insurance companies were not interested in extending the cashless facility to nursing homes as individually each nursing home has very few beds. However, by bringing in more efficient smaller nursing homes under one umbrella, NoAH can correct this anomaly, said Dr Sangeeta Pikale.

Currently, NoAH has 2,500 beds under its purview and aims to expand its network to 30,000 beds in five years.

NoAH will ensure that its members follow the code of conduct agreed with insurers/TPAs by bringing in transparency and mutually acceptable solutions. We will help the insurance companies to identify and take action against any fraudulent activity, said Dr Sudhir Naik, Chairperson, NoAH.

BRING DOWN COSTS

There is a growing tendency for insured patients to utilise tertiary level hospitals even for primary care procedures, such as diagnosing simple fever or for hernia/appendix surgery, which can be easily managed in a nursing home with efficiency and do not require a corporate hospital setup. Over-dependency on corporate hospitals is one of the reasons for healthcare inflation and high health insurance premium, said Pikale.

The association is looking at bringing common billing formats, standardised tariff charges and a common cashless authorisation format. This is line with the insurance regulator’s move to bring about standardisation in health insurance practices in the industry through its health insurance regulations which will be notified after Parliament approval.

We welcome this development. We are in talks with the AMC and will come to a consensus shortly, said Segar Sampathkumar, General Manager, New India Assurance.

Currently, NoAH has tied up with Bajaj Allianz General Insurance and is in talks with the four state-run public sector general insurers for providing cashless services.

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