HC notice to Centre,IRDA on cashless mediclaim imbroglio ….Hetal Vyas
All Is Not Well With The Health Insurance Sector
All Is Not Well With The Health Insurance Sector
Mumbai: Despite shelling out hefty premium,more than 5.5 crore consumers of medical insurance in the country have been left in the lurch after public sector insurance companies,acting through third party administrators (TPAs),suddenly stopped offering cashless mediclaim benefits to them in top hospitals in the metros.
Taking cognizance of the consumers plight,the Bombay high court,which was hearing a public interest litigation (PIL) seeking directives to restore cashless mediclaim benefits to policy holders,on Monday issued notices to the Union ministry of health and family welfare and Insurance Regulatory and Development Authority (IRDA) directing them to produce guidelines,if any,formulated for the health insurance sector.
A division bench of Chief Justice Mohit Shah and Justice S J Vazifdar issued the notices.We know that consumers are facing hardships, said Justice Vazifdar.
City-based social worker Gaurang Damani,who had filed the PIL,appeared in the court in person and argued,There is no consistency,only absolute chaos.Everyone is doing what they want.Policy holders have no idea about the status of their cashless policy or if their claims would be settled.Consumers are suffering mental agony.
Questioning the validity of TPAs,Damani,in his petition filed in February this year,pointed out that the IRDA regulations do not give TPAs the right to settle insurance claims.The petition further states that TPAs (supposedly on behalf of the insurer) started negotiating packaged treatment rates with hospitals and nursing homes to make them join their preferred provider network,thus reducing the number of hospitals/nursing homes for the consumers.TPAs are deciding packages as well as the hospital a policy holder should go to, he said,adding that there are 1,500-2,000 hospitals and nursing homes in Mumbai.Of these,he said,roughly 120 have signed with TPAs.Hearing the submissions,the judges said,TPAs are only agents.How can they fix the rate of treatments with hospitals
The Centres counsel argued that the 20-30 insurance companies operating in the health sector should be made party to the PIL.
To this,Damani said,IRDA is the regulatory authority and Centre has the final authority,there is no need to make insurance companies party individually.