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.

The Association of Healthcare Providers–India (AHPI), a body representing over 15,000 hospitals, has issued a warning that could significantly impact Star Health Insurance policyholders. The association has stated that it may suspend cashless services for these policyholders starting September 22, 2025, unless several key concerns are addressed.

Key Issues Raised by AHPI

The AHPI has highlighted several critical issues in its communication:

1. Lack of Tariff Revisions: The association points out that tariffs have not been adequately revised to keep pace with rising healthcare costs.
2. Pressure on Existing Tariffs: Hospitals are facing pressure to reduce their current tariffs.
3. Claim Deductions: Approved claims are subject to deductions.
4. Post-Approval Rejections: Claims are being rejected even after receiving final approval.
5. Abrupt Cashless Service Withdrawals: Sudden discontinuation of cashless services has been reported.

Complaint Statistics

The AHPI's concerns are further substantiated by data from the Insurance Ombudsman Annual Report 2023–24. According to this report:

Implications for Policyholders

If the AHPI follows through with its warning, the impact on Star Health Insurance policyholders could be significant:

• Cashless services at AHPI member hospitals may be suspended from September 22, 2025.
• Policyholders would still receive treatment but on a self-pay basis.
• Patients would need to seek reimbursement from Star Health Insurance after paying for their medical expenses out of pocket.

Openness to Resolution

Despite the stern warning, the AHPI has expressed willingness to engage in constructive dialogue. Dr. Girdhar Gyani, Director General of AHPI, stated that the association remains open to discussions aimed at finding a positive resolution to these issues.

This development underscores the ongoing challenges in the healthcare insurance sector, particularly concerning claim settlements and the balance between healthcare costs and insurance coverage. As the deadline approaches, both Star Health Insurance and its policyholders will be keenly watching for any developments or resolutions to this potential disruption in cashless services.