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CERS Intervenes In Medical Insurance Logjam

31 January, 2012

CERS Intervenes In Medical Insurance Logjam   
Place : Ahmedabad
Jyotsna Patel will be paid more than the assured sum of Rs 1 lakh by United India Insurance which had previously denied her claim after her husband Ambalal succumbed to a head injury.
In a similar case, Himanshu Barot was also denied insurance money after the death of his wife Jagruti, who died of blood cancer, on frivolous grounds states Consumer Education and Research Society (CERS) which has now intervened in the insurance logjam between consumers, insurance companies, third party administrators (TPAs) and doctors.
Recently, due to conflict between doctors, hospitals and insurance companies, the number consumers complaining against insurance companies have started increasing. "To solve these cases, CERS has organized a national meet in February end. Representatives of insurance companies, TPAs, medical practitioners, representatives from hospitals and consumers will be part of this meet and we plan to come out with a comprehensive solution on these issues," said Shah.
CERS intervention would help many consumers as the clash between medical fraternity and insurance companies causes patients to suffer.
According to Ahmedabad Medical Association (AMA) officials - who are still fighting public sector insurance companies - insurance companies have come up with irrational denials and cost cutting on medical insurance amounts. The companies are offering a list of fixed costs in the MoU for Preferred Provider Network (PPN) on the pretext of streamlining the service for common policy holders.
Only 92 hospitals entered the PPN network out of 1,200 hospitals in Ahmedabad. Out of it more than 40 have withdrawn in December 2011. Hospitals which sign the memorandum are categorized by insurance companies under A, B C and D grades. Hospitals under A grade are offered Rs 45,500 for coronary angiogram; hospitals under B grade are offered Rs 24,000; C grade hospitals Rs 21,000 while D grade hospitals are offered Rs16,000 for the same procedure.
"The criteria applied to grade the hospitals are not disclosed," said Dr Pragnesh Vachhrajani, joint-secretary of AMA.
"AMA has publicly appealed to the state's doctors and hospitals not to sign the recent PPN-TPA MoU due to lack of transparency and dictatorial norms, which violate rights of patients and medical practitioners, immediate past president," AMA's Dr Darbar added.

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