The Association of Healthcare Providers of India (AHPI) has called upon Star Health Insurance to immediately restore cashless services at its member hospitals, citing significant patient distress caused by service suspensions.

Major Hospital Chains Affected

The suspension of cashless services has impacted several prominent hospital chains, including:

• Care Hospitals
• Manipal Hospitals
• Max Hospitals
• Metro Hospital
• Medanta Hospital
• Rajiv Gandhi Cancer Hospital
• Sarvodaya Hospital
• Yatharth Hospitals

Delays in New Hospital Empanelment

AHPI also reported delays in the empanelment of new hospitals, affecting:

• Care Health City Vizag
• Fortis Hospital Manesar
• Jupiter Hospital Indore

Impact on Patients

The association emphasized that these actions by Star Health Insurance are forcing families to shift to reimbursement claims, which can be a more cumbersome process. Additionally, it restricts patient choice in selecting healthcare providers.

AHPI's Stance

AHPI leadership stressed that patients purchase health insurance with the expectation of receiving cashless treatment at quality hospitals. They argued that it is unjust for insurers to withhold these facilities after collecting premiums from policyholders.

Clarification on Response

The association clarified that their response was specifically directed at Star Health Insurance's actions and not a unilateral move as suggested by the General Insurance Council.

Implications for the Insurance Industry

This situation highlights the ongoing challenges in the health insurance sector, particularly regarding the relationship between insurers and healthcare providers. The dispute between AHPI and Star Health Insurance underscores the need for better coordination and understanding between these crucial stakeholders in the healthcare ecosystem.

As this situation develops, it will be important to monitor how Star Health Insurance responds to AHPI's demands and whether this issue prompts broader discussions within the insurance industry about cashless service agreements and hospital empanelment processes.

In a significant development in the health insurance sector, the General Insurance Council (GIC) has thrown its support behind Star Health and Allied Insurance Company in response to a threat from the Association of Healthcare Providers (India) (AHPI) to suspend cashless services for Star Health policyholders.

The Conflict

The AHPI, representing over 15,000 healthcare facilities across India, has announced its intention to suspend cashless services for Star Health policyholders starting September 22. This drastic measure stems from several concerns raised by the association, including:

• Delayed or denied claims
• Lack of tariff revisions despite rising healthcare costs
• Pressure on hospitals to lower tariffs

Complaints Against Star Health

The gravity of the situation is underscored by the Insurance Ombudsman Annual Report 2023-24, which recorded more than 13,300 complaints against Star Health. Notably, over 10,000 of these complaints were related to claim disputes, highlighting the extent of the issue.

GIC's Stance

The General Insurance Council has strongly condemned AHPI's unilateral approach to the situation. The council emphasized that tariff negotiations should never come at the cost of compromising patient care. In an effort to mediate the conflict, GIC had scheduled a meeting with AHPI on September 2. However, AHPI postponed this meeting indefinitely, further complicating the resolution process.

Star Health's Response

Star Health and Allied Insurance Company has responded to the situation, stating that it has not received any reports of cashless service suspension from its network partners. The insurer criticized AHPI for issuing threats without providing clarity on the situation.

In a commitment to its policyholders, Star Health has pledged to ensure that customers receive claim payments before hospital admissions if any disruptions occur. This proactive approach aims to safeguard the interests of policyholders amidst the ongoing dispute.

Implications for Policyholders

The standoff between AHPI and Star Health, if unresolved, could have significant implications for policyholders. The potential suspension of cashless services would require patients to pay for their medical expenses upfront and then claim reimbursements, which could cause financial strain and inconvenience.

As the situation unfolds, all eyes are on the stakeholders to find a resolution that balances the interests of healthcare providers, insurers, and most importantly, the patients. The outcome of this dispute could set a precedent for future interactions between healthcare providers and insurance companies in India's evolving health insurance landscape.