The General Insurance Council has set up a committee that will vet the hospitals and decide on a panel of medical centres that non-life insurers can partner with, according to a senior industry official who spoke on the condition of anonymity.
The committee also intends to establish standardised healthcare rates that would be charged by empanelled hospitals instead of separate agreements with different rates that currently exist between different hospitals and insurers, according to a report by BQ Prime. The committee has set a target date of 31 October 2023 for the list to be ready.
The Council says that the panel would deal with the challenge of overcharging and fraudulent claims by some hospitals.
As of September 2023, ICICI Lombard General Insurance has excluded about 3,000 hospitals from its list of associated hospitals because of suspicion of unscrupulous claims and overpriced medical bills and claims from the hospitals, according to a disclosure made on its website.
Many other general and health insurers constantly cull their list of associated hospitals to weed out fraudulent claims that have led to huge payouts.
The goal of the Council is to allow 100% cashless reimbursement of health insurance claims at all hospitals on the panel and allow interoperability, which would mean that a cashless reimbursement would apply to all hospitals on the common list—even if the insurer does not have an agreement with each of those hospitals.
IRDAI chairman, Mr Debasish Panda, said earlier this month that the regulator has been working with players in the health insurance ecosystem to ensure 100% cashless settlement of medical expense claims.
In May 2023, the media reported that non-life insurers were rallying around the Council to establish a platform for 100% cashless claims settlement. The objective is to help the insurers curb fraud, waste and abuse of medical insurance.
