Suspension of cashless treatment services for Bajaj Allianz, Care Health: General Insurance Council terms it “sudden unilateral action”

The “sudden unilateral action” is impacting the trust in the health insurance ecosystem.

After the Association of Healthcare Providers – India (AHPI) advised its member hospitals in north India to stop providing cashless treatment facilities for the policyholders of Bajaj Allianz General Insurance and Care Health Insurance, the General Insurance Council (GIC) on Tuesday said this “sudden unilateral action” on part of AHPI has created unnecessary confusion and concerns amongst citizens, impacting the trust in the health insurance ecosystem.

The GIC, which works as an important link between the country’s non-life insurance industry and Insurance Regulatory and Development Authority of India (IRDAI), said the industry stands “united” when an insurer is “unfairly targeted”.

Girdhar Gyani, Director General of AHPI told businessline that the association is scheduled to have a meeting with Bajaj Allianz General Insurance this Thursday, and the GIC next week, aiming to have SoPs (standard operating procedures) in place so that customers are not hurt in the impasse.

Last week, AHPI said it advised its member hospitals in north India to stop providing cashless treatment facilities for the policyholders of Bajaj Allianz General Insurance Company and Care Health Insurance from September 1.

Repeated complaints

The decision was taken after a meeting with the providers earlier this month, said AHPI. This was after “repeated complaints from AHPI members hospitals that Bajaj Allianz General Insurance Company has refused to revise hospital reimbursement rates in line with rising medical costs and, has, in fact, pressured hospitals to further reduce tariffs that were agreed upon years ago under now-expired contracts”, said the association that represents hospitals and healthcare associations across the country.

Issuing a statement, the GIC on Tuesday said this action was arbitrary, lacking clarity or actionable details.

“This sudden unilateral action on part of AHPI has created unnecessary confusion and concerns amongst citizens, impacting the trust in the health insurance ecosystem. Instead of enabling dialogue and resolution, a press statement was abruptly issued, prejudicing the interests of policyholders across the country,” GIC said.

It said the health insurance industry in India has consistently worked to make quality healthcare accessible and affordable for all. Initiatives such as Cashless Everywhere and the National Health Claims Exchange (NHCX) have been launched with the sole aim of ensuring that citizens can avail seamless treatment anywhere in the country without financial stress.

Insurers have invested heavily in building these reforms and have supported crores of health ensure enrolments and settled more than ₹87,000 crore in claims during 2023-24, a direct demonstration of their commitment to the people of India.

“The Council strongly believes that any action which disrupts cashless access ultimately harms the citizens. Disruption in cashless service not just directly impacts families through higher upfront spends on treatments and out-of-pocket expenses, it also threatens survival of patients in critical medical conditions requiring immediate medical attention. Such action on part of AHPI undermines the sanctity of a human life, especially in cases requiring emergency hospitalisation, where a policyholder should not be denied cashless treatment and be forced to make financial arrangement,” it said.

“As an industry, we stand united: when an insurer is unfairly targeted, the issue is much serious as it adversely affects interests of crores of citizens who depend on health insurance for financial protection and access to healthcare. More importantly, our solidarity is with the people of India. Patients and families must never be put to such level of uncertainty and hardships for such reasons,” GIC stated.

Significantly, APHI on last Friday said its member hospitals complained of unilateral deductions by Bajaj Allianz, delay in payments and unduly delay in issuing pre-auth and pre-discharge approvals.

Tapan Singhel, MD & CEO, Bajaj Allianz General Insurance, on Tuesday said, “We have always stood for what’s good for the citizen of our country and no undue pressure will buckle us down, none of our customers will suffer, as of now we have not received a single case of denial of cashless but even if we do we shall ensure that our customer gets the money in his/her account before they have to pay the hospital.”