Cashless medical facilities for persons insured with PSU companies are now available in 560 hospitals in four big cities and the network will be expanded to four more cities as well.
Presently 560 hospitals are included in the Preferred Provider Network (PPN) in the four cities namely Delhi, Mumbai, Chennai and Bangalore. It has also been decided to expand the PPN network to four other centers namely Ahmedabad, Kolkata, Hyderabad and Chandigarh.
Insurance companies have a network of hospitals, known as Preferred Provider Network (PPN), which offers health insurance services under cashless facility. The network hospitals are decided through the agreement between the Third Party Administrators (TPAs) and the hospitals and the list is amended from time to time.
The four PSU insurance firms - National Insurance, New India Assurance, Oriental Insurance and United India Assurance had in July last year stopped the cashless facility in select private hospitals, alleging over-billing by them.
To minimize inconvenience to the insured, Third Party Administrators (TPAs) have been advised that for emergency and trauma cases, cashless facility should be provided not only at hospitals within PPN, but at other hospitals also.
The mounting losses in this portfolio are a matter of serious concern for them. It was also observed by these companies that some of the hospitals were charging the patients having health insurance policies at rates which are quite higher than the reasonable cost of treatment.
As customers were left in a quandary post the suspension of cashless facility, the insurance regulator IRDA in August came out with a circular stating that the policy holders undergoing treatment would continue to get cashless benefit even if the hospital where they are admitted is delisted by insurers from cashless cover.
The regulator has also asked the companies to constantly update policy holders and customers on any change in the list of hospitals offering cashless cover.