Pune hospitals halt cashless treatment facility from January 1

The impasse over cashless medical services over renewal of its rate contract continues in city hospitals. Unhappy over the prolonged delay of contract renewal, city-based Deenanath Mangeshkar Hospital (DMH) from Monday, January 1, stopped offering cashless treatment facilities to policyholders of public sector insurance companies. Several hospitals in the city are unhappy over the low rates offered by the insurance companies during renewal to the hospitals.
DMH has put up a board in the hospital stating the ‘cashless facility of ICICI Lombard Insurance Company and GIPSA companies has been temporarily on hold from January 1 till further notice. The hospital also informed that the rate revision has been under discussion since October 10, 2023. The new revised rates were not approved till December 31, due to which the cashless facility has been temporarily stopped.
Hospitals in the city as preferred provider network (PPN) have long been upset and protesting the rates imposed by public sector general insurance companies—New India Assurance Company, United India Insurance Company, Oriental Insurance Company, and National Insurance Company, under the banner of General Insurance Public Sector Association (GIPSA).
The hospitals every two years renew their contract with the insurance companies. The date of renewal of the contract is different for all hospitals. However, hospitals claim every time the rates are revised are unjustified and fail to consider the rising inflation.
Dr Dhananjay Kelkar, medical director of Deenanath Mangeshkar Hospital, confirmed that the cashless facility for public sector insurance companies and one private insurance company is suspended at the hospital. The patients have to go for an alternative option of reimbursement.
Dr H K Sale, executive director of Noble Hospital and chairman of the Association of Hospitals, Pune (AHP), said, to avoid inconvenience to the patients we have accepted the rates given by insurance companies at Noble Hospital. However, many hospitals in the city are yet to renew or are in the process of renewing their contract with insurance companies.”
Dr Sale said the renewal process takes time as the insurance companies don’t agree to the revised rates given by the hospitals during the renewals.
Dr Behram Khodaji, CEO of Ruby Hall Clinic said, “For the past few months, we have been under discussion with GIPSA for renewal of our contract with them. This is a normal period, and the contract is likely to be renewed in the next couple of weeks. However, we have not stopped or suspended the cashless insurance facility for the patients,” he said.
Dr Sanjay Patil, chairman of the Hospital Board of India, Pune Chapter, currently around 80 to 90 private hospitals in the city have GIPSA empanelment. Their rate list is not scientific and due to this, the hospitals are not renewing the contract.
“Considering the rising inflation and treatment cost the hospitals expect justified rate revision. The IMA has made a rate list, but the insurance companies are not accepting the same. This is causing inconvenience to patients, who are now going for private insurance policies,” Patil said.
Dr Vinod Sawantwadkar, chief executive officer of Jehangir Hospital, said there is no issue with cashless insurance facilities at our hospital.
“We have recently renewed our contract with both public and private insurance companies. The renewals were done two months back and both the insurance companies and the hospital have accepted the revised rate list. However, different hospitals have different renewal dates of contracts,” he stated.
A Patient at DMH on anonymity, said, it was shocking to find that the hospital has stopped offering a cashless treatment facility for the GIPSA insurance company policyholder. “We were expecting to get the cashless treatment but had to pay from the pocket. However, we will later put the bill for reimbursement claim but it becomes difficult when your savings get exhausted. We had the option to visit another hospital but the doctors at DMH are good, so we decided to pay and later claim reimbursement,” said, the patient.
Despite repeated attempts, GIPSA officials could not be contacted for their comment.