Wait prolongs for settlements under health insurance scheme
01 Apr, 2014 02:02 PM
The deadlock between the Government Medical College and Hospital (GMCH) and officials of the insurance company providing services under the Rajiv Gandhi Jeevandayee Arogya Yojana (RGJAY) has been causing problems for the patients for some time now. Even after a meeting between GMCH officials and those from Paramount Health Services (TPA) on Saturday, it seems finding a solution would be an uphill task.

The meeting ended with both the parties blaming each other for the fiasco. The insurance company says the pending dues will be cleared whenever the documental and other deficiencies are sorted out. The company had rejected many claims made under the ambitious scheme during the post authorization process despite giving approval during the pre-authorization stage. In all, Rs60 lakh worth of treatment, including Rs25 lakh of GMCH patients and Rs35 lakh of SSH patients, have been rejected so far.

As per the hospital authorities, some cases were rejected just for silly reasons. "We have had to stop the medication and other procedures by means of follow-ups because the vendors have refused supplies till we pay their pending amount, and we have no money to spare. Also, the company was supposed to provide login Ids to four coordinators for the same which still has not happened," said an official from the hospital.

The insurance company had its own list of complaints. "Operations were not done for a long time even after completion of the preauthorization process in several cases. Mandatory documents which we were told would be made available were not there during the post authorization. The discharge summaries were not given to us in many cases," said Mukund Pathare, assistant project head of the company.

He said the hospital had been asking some relaxations since it is a government institution. But those relaxations, he said, would go against the government norms. He also said most of the claims are in the process and would be settled as and when the requisite documents are provided to the company.
Source : The Times Of India

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